Department of Surgery, Division of Cardiovascular Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
Ann Thorac Surg. 2012 Aug;94(2):530-6. doi: 10.1016/j.athoracsur.2012.04.034. Epub 2012 May 26.
This study was performed to investigate the early and late outcomes of total aortic arch replacement (TAR) with or without coronary artery bypass grafting (CABG).
From October 1999 to December 2010, 200 consecutive patients underwent elective TAR for nondissecting aneurysm through a median sternotomy. Of this number, 131 (65.5%) had isolated TAR (TAR group) and 69 (34.5%) underwent concomitant CABG (TAR/CABG group). Patients in the TAR/CABG group were older and had more advanced chronic kidney disease and higher additive/logistic European System for Cardiac Operative Risk Evaluation and Japan scores than patients in the TAR group.
Overall 30-day mortality was 0.5% (1 of 200) and hospital mortality was 3.5% (7 of 200). Hospital mortality was 1.5% (2 of 131) in the TAR group and 7.2% (5 of 69) in the TAR/CABG group (p=0.036). Multivariate analysis showed that operation time (odds ratio [OR] 1.01, p=0.013) was a risk factor for hospital mortality, but failed to demonstrate concomitant CABG as a risk factor. Cox proportional hazard analysis showed that age (OR 1.08, p=0.05), female sex (OR 3.58, p=0.0004), chronic kidney disease (OR 7.70, p<0.0001), and operation time (OR 1.01, p=0.0002) were risk factors for midterm mortality, whereas concomitant CABG was not (OR 0.92, p=0.87). There was a significant difference in midterm survival and freedom from major cerebrocardiovascular events in the TAR group versus the TAR/CABG group.
Concomitant CABG was not a risk factor for hospital morality with TAR. However, patients with concomitant CABG have more preoperative comorbidities, which may adversely affect outcomes, and which may therefore deserve special attention.
本研究旨在探讨全主动脉弓置换（TAR）联合或不联合冠状动脉旁路移植术（CABG）的早期和晚期结果。
自 1999 年 10 月至 2010 年 12 月，通过正中开胸术对 200 例非夹层动脉瘤患者行择期 TAR。其中，131 例（65.5%）为单纯 TAR（TAR 组），69 例（34.5%）行同期 CABG（TAR/CABG 组）。TAR/CABG 组患者年龄较大，慢性肾脏病更严重，附加/逻辑欧洲心脏手术风险评估系统和日本评分更高。
总体 30 天死亡率为 0.5%（200 例中的 1 例），住院死亡率为 3.5%（200 例中的 7 例）。TAR 组住院死亡率为 1.5%（2/131），TAR/CABG 组为 7.2%（5/69）（p=0.036）。多因素分析显示手术时间（比值比[OR]1.01，p=0.013）是住院死亡率的危险因素，但未能证明同期 CABG 是危险因素。Cox 比例风险分析显示年龄（OR1.08，p=0.05）、女性（OR3.58，p=0.0004）、慢性肾脏病（OR7.70，p<0.0001）和手术时间（OR1.01，p=0.0002）是中期死亡率的危险因素，而同期 CABG 不是（OR0.92，p=0.87）。TAR 组与 TAR/CABG 组中期生存率和无重大心脑血管事件的差异有统计学意义。
同期 CABG 不是 TAR 术后住院死亡率的危险因素。然而，同期 CABG 的患者术前合并症更多，这可能对预后产生不利影响，因此需要特别关注。
