Heinemann M, Laas J, Karck M, Borst H G
Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Federal Republic of Germany.
Ann Thorac Surg. 1990 Apr;49(4):580-4. doi: 10.1016/0003-4975(90)90304-o.
Between April 1979 and May 1989, 86 patients underwent emergency operation for acute type A aortic dissection. Sixty-four (74.4%) survived. None of the survivors died of late aortic complications. Fifty-eight patients were followed 3 months to 10 years (mean follow-up, 3.2 years) postoperatively with computed tomography and digital subtraction angiography. Dilatation of the distal aorta (diameter size range, 6 to 10.5 cm) developed in 10 patients (17%). Six patients underwent replacement of the descending aorta 1 month to 21 months (mean period, 8.5 months) after aortic dissection repair. Two of them had third-stage thoracoabdominal replacement. In 2 patients, replacement of the descending aorta was scheduled; 1 died before reoperation and 1 refused the procedure. Two patients underwent aortic arch replacement; it is scheduled for another (fourth stage). There were no deaths among the patients having reoperation. The rate of indications for reoperation on the aorta downstream from the original repair 1 month to 6 years 4 months (median time, 9 months) after primary surgical intervention for acute type A aortic dissection was 24% (14 reoperations in 10 of 58 patients). This study underscores the importance of close follow-up of patients having operation for acute type A aortic dissection. Early recognition of progressive downstream aortic pathology permits effective prevention of aortic rupture and timely reoperation.
1979年4月至1989年5月期间，86例患者因急性A型主动脉夹层接受了急诊手术。64例（74.4%）存活。所有幸存者均未死于晚期主动脉并发症。58例患者术后接受了3个月至10年（平均随访3.2年）的计算机断层扫描和数字减影血管造影检查。10例患者（17%）出现了远端主动脉扩张（直径范围为6至10.5 cm）。6例患者在主动脉夹层修复术后1个月至21个月（平均8.5个月）接受了降主动脉置换术。其中2例进行了三期胸腹主动脉置换术。2例患者计划进行降主动脉置换术；1例在再次手术前死亡，1例拒绝手术。2例患者接受了主动脉弓置换术；另有1例（第四期）计划进行该手术。再次手术的患者均未死亡。急性A型主动脉夹层初次手术干预后1个月至6年4个月（中位时间9个月），原修复部位下游主动脉再次手术的指征率为24%（58例患者中的10例进行了14次再次手术）。本研究强调了对急性A型主动脉夹层手术患者进行密切随访的重要性。早期识别进展性的下游主动脉病变可有效预防主动脉破裂并及时进行再次手术。
