Modi Amit, Vohra Hunaid A, Kaarne Markku, Haw Marcus P, Barlow Clifford W, Ohri Sunil K, Livesey Steven A, Tsang Geoffrey M K
Wessex Cardiothoracic Centre, Southampton University Hospitals NHS Trust, Southampton, SO16 6YD, UK.
Interact Cardiovasc Thorac Surg. 2011 Oct;13(4):386-91. doi: 10.1510/icvts.2011.266692. Epub 2011 Jul 5.
We evaluated the outcome after repair for acute spontaneous type A aortic dissection in patients with previous cardiac surgery. From January 2000 to December 2009, 114 patients underwent emergency repair for acute spontaneous type A dissection at Southampton University Hospital. Eleven (median age 64 years; range 36-83 years; two females) patients (9.8%) had undergone previous cardiac surgery and were included in this study. Aortic root replacement was performed in three patients (27%), aortic arch replacement in four patients (36%) and two patients (18%) required aortic valve re-suspension. The elephant trunk operation was performed in two patients (18%). There were two hospital deaths (18%). Two patients (18%) suffered a stroke, two needed re-opening for bleeding (18%) and two patients (18%) required haemofiltration postoperatively. Median length of hospital stay was 16 days (range 6-34 days). Actuarial survival at five and eight years for redo compared to first-time surgery was 68±3.63% vs. 81±5.34% and 51±3.8% vs. 61±5.4%, respectively (P=0.365). In conclusion, acute type A aortic dissection repair in patients with previous cardiac surgery has an acceptable mortality and comparable long-term outcome to first-time surgery.
我们评估了曾接受心脏手术的患者急性自发性A型主动脉夹层修复术后的结局。2000年1月至2009年12月，114例患者在南安普敦大学医院接受了急性自发性A型夹层的急诊修复。11例（中位年龄64岁；范围36 - 83岁；2例女性）患者（9.8%）曾接受过心脏手术，纳入本研究。3例患者（27%）进行了主动脉根部置换，4例患者（36%）进行了主动脉弓置换，2例患者（18%）需要重新悬吊主动脉瓣。2例患者（18%）进行了象鼻手术。有2例医院死亡（18%）。2例患者（18%）发生中风，2例因出血需要再次开胸（18%），2例患者（18%）术后需要血液滤过。中位住院时间为16天（范围6 - 34天）。再次手术与首次手术相比，5年和8年的精算生存率分别为68±3.63%对81±5.34%和51±3.8%对61±5.4%（P = 0.365）。总之，曾接受心脏手术的患者急性A型主动脉夹层修复术的死亡率可接受，长期结局与首次手术相当。
