开放手术修复胸降主动脉瘤在血管内治疗时代的手术结果。
Operative outcomes after open repair of descending thoracic aortic aneurysms in the era of endovascular surgery.
机构信息
The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
The Aortic Wellness Center, Division of Cardiothoracic Surgery, Lenox Hill Hospital, North Shore LIJ Hospital System, New York, New York.
出版信息
Ann Thorac Surg. 2014 May;97(5):1562-7. doi: 10.1016/j.athoracsur.2014.01.046. Epub 2014 Mar 15.
BACKGROUND
Since the advent of endovascular techniques for repair of descending thoracic aortic aneurysms (DTAAs), there has been a relative paucity of current data for open repairs. The purpose of this study was to assess the operative and long-term outcomes in a contemporary series of open repairs of DTAAs.
METHODS
We conducted a retrospective review of 68 patients (63±14.5 years) who underwent DTAA repairs between January 1999 and December 2010. Forty-two patients (62%) were male, 16 (24%) had chronic obstructive pulmonary disease, 7 (10%) required dialysis preoperatively, 11 (16%) had contained rupture, 25 (37%) had previous cardioaortic operations, and 10 (15%) had previous aortic arch replacement (stage 1 elephant trunk). The entire descending thoracic aorta was replaced in 34 patients (50%). Cardiopulmonary bypass was used in 64 patients (94%) and deep hypothermic arrest in 22 (32%).
RESULTS
In-hospital mortality was 3% (2 patients). There was no immediate paraplegia. Delayed paraplegia developed in 1 patient (1.5%). Postoperative stroke occurred in 3 patients (4.4%), and 20 (29%) required prolonged ventilatory support (intubation≥48 hours). New-onset renal insufficiency (creatinine≥2.5 mg/dL) developed postoperatively in 6 patients (9%), and 1 (1.5%) required temporary dialysis. The median follow-up time was 5.8±3.8 years. Sixteen of the 66 operative survivors (24.2%) died during follow-up. Probability of survival was 82%±0.05% at 5 years and 67%±0.07% at 10 years. Reintervention was necessary in 4 patients (6%). Freedom from reintervention was 98%±0.02% at 5 years and 89%±0.06% at 10 years. The univariable predictor of long-term death was postoperative reintubation (p<0.05).
CONCLUSIONS
In the era of endovascular repair of DTAAs, operative death and morbidity outcomes for open repairs are observed to be low. In addition to good long-term survival rates, open repairs are durable, as evidenced by low reintervention rates.
背景
自从腔内技术用于修复降主动脉夹层瘤（DTAAs）以来，目前有关开放修复的最新数据相对较少。本研究旨在评估一组当代 DTAAs 开放修复的手术和长期结果。
方法
我们回顾性分析了 1999 年 1 月至 2010 年 12 月期间接受 Dtaa 修复的 68 例患者（63±14.5 岁）。42 例（62%）为男性，16 例（24%）患有慢性阻塞性肺疾病，7 例（10%）术前需要透析，11 例（16%）为包裹性破裂，25 例（37%）有既往心主动脉手术史，10 例（15%）有既往主动脉弓置换术（一期象鼻手术）。34 例（50%）患者行全降主动脉置换。64 例（94%）患者采用体外循环，22 例（32%）采用深低温停循环。
结果
院内死亡率为 3%（2 例）。无即刻截瘫。1 例（1.5%）发生迟发性截瘫。术后发生脑卒中 3 例（4.4%），20 例（29%）需要长时间机械通气（插管>48 小时）。6 例（9%）术后新发肾功能不全（肌酐≥2.5mg/dL），1 例（1.5%）需要临时透析。中位随访时间为 5.8±3.8 年。66 例手术存活者中，16 例（24.2%）在随访期间死亡。5 年生存率为 82%±0.05%，10 年生存率为 67%±0.07%。4 例（6%）需要再次干预。5 年无再干预率为 98%±0.02%，10 年无再干预率为 89%±0.06%。单变量预测长期死亡的因素是术后重新插管（p<0.05）。
结论
在腔内修复 DTAAs 的时代，开放修复的手术死亡率和发病率均较低。除了良好的长期生存率外，开放修复的耐久性也很好，再干预率较低。
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