Numata Satoshi, Tsutsumi Yasushi, Monta Osamu, Yamazaki Sachiko, Seo Hiroyuki, Yoshida Shohei, Samura Takaaki, Ohashi Hirokazu
Department of Cardiovascular Surgery, Fukui Cardiovascular Center, Fukui, Japan.
J Card Surg. 2013 Sep;28(5):537-42. doi: 10.1111/jocs.12166. Epub 2013 Jul 21.
The purpose of this study is to evaluate mid-long-term results of aortic arch replacement.
Between 1992 and 2012, 263 consecutive patients underwent aortic arch repair in our institution. Follow-up rate was 92%, and 243 patients were enrolled in this study. Two hundred twelve patients (87%) underwent total arch replacement using a four-branched graft with antegrade selective cerebral perfusion. Ninety-nine patients (41%) were operated on for acute aortic dissection.
Hospital mortality was 13.2%. The mean follow-up duration was 3.6 ± 3.7 (0-19) years. Late mortality occurred in 38 patients, 4.3 ± 3.2 (0.3-14.1) years after surgery. The survival rates were 85%, 70%, and 50% at one, five, and 10 years. In the acute type A aortic dissection group, survival rate at one and five years was 86% and 79%. In the nonacute type A dissection group, one- and five-year survivals were 85% and 62% (log-rank test: p=0.0027). The causes of late mortality were respiratory failure in five, aortic aneurysm rupture in six, cancer in four, stroke in eight, others in seven, and unknown in eight. Twenty-six patients had another aortic intervention 3.6 ± 6.0 (0.04-19.6) years after arch repair. Seven patients had stroke after discharge 6.5 ± 3.9 (1.9-13.0) years after repair.
Mid-long-term results after aortic arch repair with antegrade selective cerebral perfusion were satisfactory. Acute type A aortic dissection did not negatively influence the mid-long-term survival.
本研究旨在评估主动脉弓置换术的中长期结果。
1992年至2012年期间，我院连续263例患者接受了主动脉弓修复术。随访率为92%，243例患者纳入本研究。212例患者（87%）使用四分支移植物并采用顺行性选择性脑灌注进行全弓置换。99例患者（41%）因急性主动脉夹层接受手术。
住院死亡率为13.2%。平均随访时间为3.6±3.7（0 - 19）年。38例患者出现晚期死亡，术后4.3±3.2（0.3 - 14.1）年。1年、5年和10年生存率分别为85%、70%和50%。在急性A型主动脉夹层组，1年和5年生存率分别为86%和79%。在非急性A型夹层组，1年和5年生存率分别为85%和62%（对数秩检验：p = 0.0027）。晚期死亡原因包括呼吸衰竭5例、主动脉瘤破裂6例、癌症4例、中风8例、其他原因7例、不明原因8例。26例患者在弓修复术后3.6±6.0（0.04 - 19.6）年接受了另一次主动脉干预。7例患者在修复术后6.5±3.9（1.9 - 13.0）年出院后发生中风。
采用顺行性选择性脑灌注进行主动脉弓修复术的中长期结果令人满意。急性A型主动脉夹层对中长期生存无负面影响。
