开放式胸腹主动脉瘤修复的结果。

Results of open thoracoabdominal aortic aneurysm repair.

机构信息

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.

出版信息

Ann Cardiothorac Surg. 2012 Sep;1(3):286-92. doi: 10.3978/j.issn.2225-319X.2012.08.16.

DOI:10.3978/j.issn.2225-319X.2012.08.16

PMID:23977510

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3741780/

Abstract

BACKGROUND

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.

METHODS

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%).

RESULTS

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%).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。