Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine; and Department of Cardiovascular Surgery, The Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas, USA.
Ann Cardiothorac Surg. 2012 Sep;1(3):286-92. doi: 10.3978/j.issn.2225-319X.2012.08.16.
Open surgical repair of thoracoabdominal aortic aneurysms (TAAAs) enables the effective replacement of the diseased aortic segment and reliably prevents aneurysm rupture. However, these operations also carry substantial risk of perioperative morbidity and mortality, principally caused by the associated ischemic insult involving the spinal cord, kidneys, and other abdominal viscera. Here, we describe the early outcomes of a contemporary series of open TAAA repairs.
We reviewed the outcomes of 823 open TAAA repairs performed between January 2005 and May 2012. Of these, 209 (25.4%) were Crawford extent I repairs, 264 (32.1%) were extent II, 157 (19.1%) were extent III, and 193 (23.5%) were extent IV. Aortic dissection was present in 350 (42.5%) cases, and aneurysm rupture was present in 37 (4.5%). Adjuncts used during the procedures included cerebrospinal fluid drainage in 639 (77.6%) cases, left heart bypass in 430 (52.2%), and cold renal perfusion in 674 (81.9%).
The composite endpoint, adverse outcome-defined as operative death, renal failure that necessitated dialysis at discharge, stroke, or permanent paraplegia or paraparesis-occurred after 131 (15.9%) procedures. There were 69 (8.4%) operative deaths. Permanent paraplegia or paraparesis occurred after 42 (5.1%) cases, stroke occurred after 27 (3.3%), and renal failure necessitating permanent dialysis occurred after 45 (5.5%).
Although open surgical repair of the thoracoabdominal aorta can be life-saving to patients at risk for fatal aneurysm rupture, these operations remain challenging and are associated with substantial risk of early death and major complications. Additional improvements are needed to further reduce the risks associated with TAAA repair, particularly as increasing numbers of patients with advanced age and multiple or severe comorbidities present for treatment.
开放性胸主动脉瘤（TAAA）修复术可有效置换病变的主动脉节段，并可靠地防止瘤破裂。然而，这些手术也存在大量围手术期发病率和死亡率的风险，主要是由脊髓、肾脏和其他腹部内脏的相关缺血性损伤引起的。在此，我们描述了一系列当代开放性 TAAA 修复的早期结果。
我们回顾了 2005 年 1 月至 2012 年 5 月期间进行的 823 例开放性 TAAA 修复的结果。其中，209 例（25.4%）为 Crawford Ⅰ型修复，264 例（32.1%）为Ⅱ型，157 例（19.1%）为Ⅲ型，193 例（23.5%）为Ⅳ型。350 例（42.5%）患者存在主动脉夹层，37 例（4.5%）存在动脉瘤破裂。手术过程中使用的辅助手段包括：639 例（77.6%）患者使用脑脊液引流，430 例（52.2%）患者使用左心旁路，674 例（81.9%）患者使用低温肾灌注。
复合终点（定义为手术死亡、出院时需要透析的肾衰竭、中风或永久性截瘫或截瘫）发生在 131 例（15.9%）手术中。有 69 例（8.4%）手术死亡。42 例（5.1%）发生永久性截瘫或截瘫，27 例（3.3%）发生中风，45 例（5.5%）发生需要永久性透析的肾衰竭。
尽管开放性胸主动脉瘤修复术可以挽救有致命性瘤破裂风险的患者的生命，但这些手术仍然具有挑战性，且早期死亡和主要并发症的风险很大。需要进一步改进，以进一步降低 TAAA 修复的相关风险，特别是随着越来越多的高龄患者和存在多种或严重合并症的患者接受治疗。
