Lu Shuyang, Yang Shouguo, Lai Hao, Zheng Jiayu, Hong Tao, Sun Xiaoning, Wang Chunsheng
Shanghai Institute of Cardiovascular Disease, Zhongshan Hospital, Fudan University, Shanghai, China.
Department of Cardiovascular Surgery, Zhongshan Hospital, Fudan University, Shanghai, China.
J Cardiothorac Surg. 2016 Jul 22;11(1):111. doi: 10.1186/s13019-016-0500-5.
This study aimed to analyze the mortality and morbidity of patients undergoing open aortic arch reconstruction for acute type A aortic dissection.
Between September 2005 and January 2012, 267 consecutive patients underwent open aortic arch reconstruction for acute type A aortic dissection at our center. The mean age was 51.2 ± 10.0 years, and 200 patients were male. Sixty-three and 184 patients underwent hemiarch replacement and total arch replacement, respectively, whereas the remaining 20 patients underwent single- or triple-branched stent graft implantation. Long-term mortality was estimated by Kaplan-Meier method.
The in-hospital and operative mortality rates within 30 days were 11.2 % and 8.2 %, respectively. The cardiopulmonary bypass, myocardial ischemic, and antegrade cerebral perfusion times were 150.2 ± 43.3, 71.9 ± 33.2, and 33.6 ± 14.4 min, respectively. The overall in-hospital and intensive care unit durations and mean ventilation time were 23.9 ± 18.4 and 9.5 ± 12.7 days and 122.7 ± 183.4 h, respectively. We observed new postoperative permanent neurological dysfunction in 29 patients and temporary neurological dysfunction in 17 patients. The mean follow-up duration was 52.4 ± 27.9 months; 76.4 % of patients completed follow-up and 143 remained alive. Overall long-term survival was 82.2 % at 5 years.
The open aortic arch reconstruction technique for acute type A dissection carries a relatively high in-hospital mortality risk, although the late results are encouraging. Patients with an advanced age or impaired renal function may opt for endovascular or modified single- or triple-branched stent graft implantation therapy.
本研究旨在分析接受急性A型主动脉夹层开放主动脉弓重建术患者的死亡率和发病率。
2005年9月至2012年1月期间，267例连续患者在本中心接受了急性A型主动脉夹层开放主动脉弓重建术。平均年龄为51.2±10.0岁，男性200例。分别有63例和184例患者接受了半弓置换和全弓置换，其余20例患者接受了单分支或三分支支架植入术。采用Kaplan-Meier法估计长期死亡率。
30天内的住院死亡率和手术死亡率分别为11.2%和8.2%。体外循环、心肌缺血和顺行脑灌注时间分别为150.2±43.3、71.9±33.2和33.6±14.4分钟。总的住院时间、重症监护病房时间和平均通气时间分别为23.9±18.4天、9.5±12.7天和122.7±183.4小时。我们观察到29例患者出现新的术后永久性神经功能障碍，17例患者出现暂时性神经功能障碍。平均随访时间为52.4±27.9个月；76.4%的患者完成了随访，143例患者仍存活。5年时的总体长期生存率为82.2%。
急性A型夹层的开放主动脉弓重建技术虽然后期结果令人鼓舞，但住院死亡率风险相对较高。年龄较大或肾功能受损的患者可选择血管内或改良单分支或三分支支架植入治疗。
