Stamou Sotiris C, Kouchoukos Nicholas T, Hagberg Robert C, Khabbaz Kamal R, Robicsek Francis, Nussbaum Marcy, Lobdell Kevin W
Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, MO, USA.
Interact Cardiovasc Thorac Surg. 2011 Mar;12(3):404-8. doi: 10.1510/icvts.2010.256131. Epub 2010 Dec 20.
The purpose of this study was to evaluate clinical outcomes of two different surgical techniques for the repair of acute type A dissection: open distal anastomosis under deep hypothermic circulatory arrest (DHCA) compared with distal aortic clamping on hypothermic cardiopulmonary bypass (ACPB). Between January 2000 and July 2008, 82 patients underwent DHCA and 42 had ACPB. Major morbidity, operative mortality and five-year actuarial survival were compared between groups. There were no significant differences in the preoperative characteristics. Operative mortality (17% in DHCA vs. 21% in ACPB, P=0.63), reoperation for bleeding (20% in DHCA vs. 34% in ACPB, P=0.16) and stroke rates (16 DHCA vs. 24% in ACPB, P=0.33) were comparable between the two groups. Actuarial five-year survival rates were 74% for DHCA vs. 73% for ACPB, P=0.99. No significant differences in operative mortality, major morbidity and actuarial five-year survival were observed between DHCA and ACPB. There are some practical technical advantages if the distal anastomosis is performed in an open manner. More studies are required to determine the fate of the false lumen between the two techniques.
本研究的目的是评估两种不同手术技术修复急性A型主动脉夹层的临床结果：在深低温循环停搏（DHCA）下进行开放远端吻合术与在低温体外循环（ACPB）下进行远端主动脉钳夹术。2000年1月至2008年7月期间，82例患者接受了DHCA，42例接受了ACPB。对两组之间的主要并发症、手术死亡率和五年精算生存率进行了比较。术前特征无显著差异。两组的手术死亡率（DHCA组为17%，ACPB组为21%，P = 0.63）、因出血再次手术率（DHCA组为20%，ACPB组为34%，P = 0.16）和卒中发生率（DHCA组为16%，ACPB组为24%，P = 0.33）相当。DHCA组的五年精算生存率为74%，ACPB组为73%，P = 0.99。DHCA和ACPB在手术死亡率、主要并发症和五年精算生存率方面未观察到显著差异。如果以开放方式进行远端吻合术，存在一些实际的技术优势。需要更多研究来确定两种技术之间假腔的转归。
