Estrera Anthony L, Jan Azam, Sandhu Harleen, Shalhub Sherene, Medina-Castro Mario, Nguyen Tom C, Azizzadeh Ali, Charlton-Ouw Kristofer, Miller Charles C, Safi Hazim J
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
Department of Cardiothoracic and Vascular Surgery, Clinical Science Program, The University of Texas Medical School at Houston and Memorial Hermann Hospital, Houston, Texas.
Ann Thorac Surg. 2015 Mar;99(3):786-93; discussion 794. doi: 10.1016/j.athoracsur.2014.08.077. Epub 2015 Jan 21.
This study analyzed early and late outcomes after open repair of descending thoracic aortic aneurysms with chronic aortic dissection.
We retrospectively reviewed our cases of open repair of descending thoracic aortic aneurysms with chronic dissection from 1991 to 2011. Patient comorbid conditions and operative details were analyzed to determine risks for adverse outcome. Long-term survival and aortic reinterventions were analyzed.
We repaired 519 patients with descending thoracic aortic aneurysms during the study period, and 209 (40%) had chronic dissection. Mean age was 59 years, with 74% (154 of 209) men. Previous ascending repair was performed in 41% (85 of 209), and the second-stage elephant trunk was performed in 10% (21 of 209). Adjunctive distal aortic perfusion with cerebral spinal fluid drainage was used in 90% (188 of 209) of patients, and circulatory arrest with bypass in 1% (3 of 209). The 30-day mortality was 8.6% (18 of 209). Immediate neurologic deficit occurred in 0.95% (2 of 209) and only with extent C resection. Delayed neurologic deficit occurred in 1.4% (3 of 209), 1 patient in each extent. Because 66% (2 of 3) of the patients with delayed neurologic deficit recovered function, permanent deficit occurred in 1.4% (3 of 209). Stroke occurred in 2.4% (5 of 209) and dialysis on discharge in 5% (11 of 211). The only risk factor for 30-day mortality was preoperative glomerular filtration rate of less than 60 mL/min (odds ratio, 4.2; p < 0.006). Survival at 5, 10, and 15 years was 72%, 60%, and 49%, respectively. Freedom from reoperation on the operated-on segment was 98%, 96.5%, 96.5%, and 96.5% at 5, 10, 15, and 20 years.
Open repairs of chronic descending thoracic aortic aneurysm dissections can be performed with respectable morbidity and mortality. Neurologic deficit remains low with the use of adjuncts, and early deaths are directly related to preoperative renal status. Reintervention on the involved aortic segment is low. These results allow comparisons with endovascular repair for chronic aortic dissection.
本研究分析了开放性修复慢性主动脉夹层的降主动脉瘤的早期和晚期结果。
我们回顾性分析了1991年至2011年期间开放性修复慢性夹层降主动脉瘤的病例。分析患者的合并症和手术细节以确定不良结局的风险。分析长期生存率和主动脉再次干预情况。
在研究期间，我们为519例降主动脉瘤患者进行了修复，其中209例（40%）患有慢性夹层。平均年龄为59岁，男性占74%（209例中的154例）。41%（209例中的85例）曾接受过升主动脉修复，10%（209例中的21例）进行了二期象鼻手术。90%（209例中的188例）的患者使用了辅助性远端主动脉灌注并进行脑脊液引流，1%（209例中的3例）采用体外循环下循环停止。30天死亡率为8.6%（209例中的18例）。即刻神经功能缺损发生率为0.95%（209例中的2例），且仅发生在C型切除范围时。延迟性神经功能缺损发生率为1.4%（209例中的3例），每个切除范围各有1例患者。由于66%（3例中的2例）延迟性神经功能缺损患者恢复了功能，永久性神经功能缺损发生率为1.4%（209例中的3例）。中风发生率为2.4%（209例中的5例），出院时需要透析的发生率为5%（211例中的11例）。30天死亡率的唯一危险因素是术前肾小球滤过率低于60 mL/分钟（比值比，4.2；p < 0.006）。5年、10年和15年的生存率分别为72%、60%和49%。手术节段免于再次手术的比例在5年、10年、15年和20年分别为98%、96.5%、96.5%和96.5%。
开放性修复慢性降主动脉瘤夹层的发病率和死亡率尚可接受。使用辅助手段后神经功能缺损发生率仍然较低，早期死亡与术前肾功能状态直接相关。受累主动脉节段的再次干预率较低。这些结果可用于与慢性主动脉夹层的血管腔内修复进行比较。
