University of British Columbia, Vancouver, British Columbia, Canada.
J Am Coll Surg. 2011 Apr;212(4):569-79; discussion 579-81. doi: 10.1016/j.jamcollsurg.2010.12.041.
Recent technologic advances in endovascular devices have led to alternative approaches to thoracoabdominal aortic aneurysm (TAAA) repair; these innovative approaches must be compared with the "gold standard" of conventional open TAAA repair. To facilitate such comparisons, we evaluated contemporary outcomes of open TAAA repair.
We retrospectively reviewed and analyzed data collected prospectively between May 2006 and October 2010 regarding 509 consecutive patients who underwent TAAA repair. Standard univariate statistical comparisons were performed, as well as multivariable modeling, to identify predictors of survival.
A total of 305 patients (59.9%) had degenerative aneurysms without dissection, and 204 (40.1%) had aortic dissection. There were 104 (20.4%) urgent or emergent repairs and 26 (5.1%) ruptured aneurysms. Operative adjuncts were used selectively. Of the 290 patients (57.0%) who underwent extensive repairs (Crawford extents I and II), 282 (97.2%) had cerebrospinal fluid drainage, 257 (88.6%) had left heart bypass, and 213 (73.4%) had intercostal/lumbar artery reattachment. The overall operative survival rate was 92.1% (469 of 509), and survival was better after elective repairs (93.8% [380 of 405]) than after urgent or emergent operations (85.6% [89 of 104], p = 0.005). Renal failure necessitating hemodialysis at discharge developed in 30 patients (5.9%). Permanent paraplegia occurred in 13 patients (2.6%). Actuarial survival was 79.1% ± 2.0% at 2 years.
Contemporary open TAAA repair is characterized by respectable early outcomes, particularly when repair is elective. Such results should be compared with those of evolving approaches, including endovascular and hybrid repairs.
血管内设备的最新技术进步为胸主动脉瘤（TAAA）的修复提供了替代方法；这些创新方法必须与传统的开放式 TAAA 修复的“金标准”进行比较。为了便于进行此类比较，我们评估了开放式 TAAA 修复的当代结果。
我们回顾性地审查和分析了 2006 年 5 月至 2010 年 10 月期间前瞻性收集的 509 例连续 TAAA 修复患者的数据。进行了标准的单变量统计比较，以及多变量建模，以确定生存的预测因素。
共有 305 例（59.9%）患者为无夹层的退行性动脉瘤，204 例（40.1%）为主动脉夹层。急症或紧急修复 104 例（20.4%），破裂动脉瘤 26 例（5.1%）。选择性使用手术辅助。在 290 例（57.0%）接受广泛修复（Crawford 范围 I 和 II）的患者中，282 例（97.2%）行脑脊液引流，257 例（88.6%）行左心旁路，213 例（73.4%）行肋间/腰动脉再附着。总体手术存活率为 92.1%（509 例中的 469 例），择期手术的存活率优于急症或紧急手术（93.8%[380 例中的 380 例]比 85.6%[104 例中的 89 例]，p=0.005）。出院时需要血液透析的肾衰竭发生在 30 例（5.9%）患者中。永久性截瘫发生在 13 例（2.6%）患者中。2 年时的累积生存率为 79.1%±2.0%。
当代开放式 TAAA 修复的特点是早期结果令人满意，特别是在择期手术时。这些结果应与不断发展的方法进行比较，包括血管内和杂交修复。
