Piccardo Alessandro, Regesta Tommaso, Le Guyader Alexandre, Di Lorenzo Nicola, Bertin François, Pesteil Francis, Cornu Elisabeth
Service de chirurgie thoracique et cardiovasculaire, CHU Dupuytren, avenue Martin-Luther-King, 87000 Limoges, France.
San Martino University Hospital, Genova, Italy.
Arch Cardiovasc Dis. 2017 Jan;110(1):14-25. doi: 10.1016/j.acvd.2016.05.007. Epub 2016 Dec 21.
Long-term survival and risk of reoperation in "non-Marfan syndrome" patients with a long life expectancy who undergo emergency surgery for acute type A aortic dissection (aTAAD) are not well known.
To analyse survival, risk of reoperation and quality of life in this population.
From 1990 to 2010, all patients aged≤50 years and not affected by Marfan syndrome, who underwent emergency surgery for aTAAD at two institutions, were included in this analysis. Patients were categorized into four groups according to the extension of the aortic replacement: SUPRACORONARY, ROOT, ARCH and EXTENSIVE.
Sixty-six patients (mean age 45±4 years; range 34-50 years) were considered eligible for this analysis. Overall in-hospital mortality was 24% (16/66 patients); and 25%, 23%, 20.5% and 43% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Mean follow-up among survivors was 10.5±7.2 years (range: 0.1-24.7 years). Overall 10-year survival was 55±6%; and 75±12%, 69±13%, 47±8% and 28±17% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Overall freedom from reoperation on the aorta was 73±7.5%; and 40±20%, 75±21%, 78±8% and 100% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively.
In our experience, patients who underwent isolated supracoronary ascending aorta or root replacement showed the most satisfactory late survival. However, because the risk of reoperation is low when the replacement is extended to the root, our data suggest that root replacement could represent a good compromise between operative mortality and long-term survival.
对于预期寿命较长的“非马凡综合征”患者，因急性A型主动脉夹层（aTAAD）接受急诊手术的长期生存率和再次手术风险尚不清楚。
分析该人群的生存率、再次手术风险和生活质量。
1990年至2010年期间，两家机构中所有年龄≤50岁且未患马凡综合征、因aTAAD接受急诊手术的患者纳入本分析。根据主动脉置换范围将患者分为四组：冠状动脉上、根部、弓部和广泛型。
66例患者（平均年龄45±4岁；范围34 - 50岁）符合本分析条件。总体住院死亡率为24%（16/66例患者）；冠状动脉上、根部、弓部和广泛型组分别为25%、23%、20.5%和43%。幸存者的平均随访时间为10.5±7.2年（范围：0.1 - 24.7年）。总体10年生存率为55±6%；冠状动脉上、根部、弓部和广泛型组分别为75±12%、69±13%、47±8%和28±17%。主动脉总体免于再次手术率为73±7.5%；冠状动脉上、根部、弓部和广泛型组分别为40±20%、75±21%、78±8%和100%。
根据我们的经验，接受单纯冠状动脉上升主动脉或根部置换的患者术后晚期生存率最令人满意。然而，由于当置换范围扩大到根部时再次手术风险较低，我们的数据表明根部置换可能是手术死亡率和长期生存率之间的良好折衷方案。
