Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky 40202, USA.
Ann Thorac Surg. 2011 Sep;92(3):873-9. doi: 10.1016/j.athoracsur.2011.04.093.
Porcine bioprosthesis (bioroots) are an attractive surgical strategy for ascending aorta and arch replacement. This study evaluated the perioperative and late outcomes using this strategy for proximal aortic aneurysmal disease.
Between March 1998 and November 2009, 170 patients (40% women; median age, 70 years) underwent proximal thoracic aortic replacement using the Freestyle (Medtronics Inc, Minneapolis, MN) bioroot, with graft extension in 149 (87.6%). Aneurysmal etiology included degenerative-atherosclerotic (91.2%), acute dissection (5.3%), and chronic dissection (3.5%); 78% had greater than moderate aortic insufficiency. Surgical procedures were bioroot alone or with aortoplasty (12.3%), bioroot with ascending aortic graft (38.2%), bioroot with hemiarch graft (44.1%), and bioroot with total arch (5.3%). Hypothermic circulatory arrest was required in 49%.
The 30-day mortality was 4.7% (n=8). The overall complication rate was 58% (n=100), including stroke (6.5%), renal failure (9.2%), respiratory failure (25.9%), and postoperative bleeding (7.6%). Mean hospitalization was 10.5±7.3 days; 38 were discharged to a rehabilitation facility (23.5%). Predictors of 30-day/hospital death were coronary artery disease (p=0.0003), renal insufficiency (p<0.0001), emergent/urgent procedure (p=0.02), and hypothermic circulatory arrest (p=0.002). The 1-year, 5-year, and 10-year survivals were 90%, 80%, and 35% respectively. Freedom from endocarditis and reoperation was 96% at 1 year and 94% and 95% at 5 years, respectively.
Proximal thoracic aortic replacement using a porcine bioroot as part of the repair can be achieved with low perioperative mortality and acceptable late survival in a predominantly elderly population.
猪生物瓣（bioroots）是一种有吸引力的手术策略，可用于升主动脉和弓部替换。本研究评估了使用该策略治疗近端主动脉瘤疾病的围手术期和晚期结果。
1998 年 3 月至 2009 年 11 月期间，170 例患者（40%为女性；中位年龄 70 岁）接受了使用 Freestyle（美敦力公司，明尼苏达州明尼阿波利斯）bioroot 的近端胸主动脉置换，其中 149 例（87.6%）进行了移植物延伸。动脉瘤的病因包括退行性-动脉粥样硬化性（91.2%）、急性夹层（5.3%）和慢性夹层（3.5%）；78%有中度以上主动脉瓣关闭不全。手术方法包括单独使用 bioroot 或主动脉成形术（12.3%）、bioroot 联合升主动脉移植物（38.2%）、bioroot 联合半弓移植物（44.1%）和 bioroot 联合全弓移植物（5.3%）。49%需要低温体外循环。
30 天死亡率为 4.7%（n=8）。总并发症发生率为 58%（n=100），包括卒中（6.5%）、肾衰竭（9.2%）、呼吸衰竭（25.9%）和术后出血（7.6%）。平均住院时间为 10.5±7.3 天；38 人出院至康复中心（23.5%）。30 天/住院死亡的预测因素包括冠状动脉疾病（p=0.0003）、肾功能不全（p<0.0001）、紧急/紧急手术（p=0.02）和低温体外循环（p=0.002）。1 年、5 年和 10 年生存率分别为 90%、80%和 35%。1 年时的无心内膜炎和再次手术率为 96%，5 年时为 94%和 95%。
在主要为老年人群中，使用猪生物瓣作为修复一部分进行近端胸主动脉置换可实现低围手术期死亡率和可接受的晚期存活率。
