Yoshitake Akihiro, Okamoto Kazuma, Yamazaki Masataka, Kimura Naritaka, Hirano Akinori, Iida Yasunori, Abe Takayuki, Shimizu Hideyuki
Department of Cardiovascular Surgery, Keio University School of Medicine, Tokyo, Japan.
Department of Preventive Medicine and Public Health, Biostatistics Unit at Clinical Translational Research Center, Keio University School of Medicine, Tokyo, Japan.
Eur J Cardiothorac Surg. 2017 Jun 1;51(6):1142-1148. doi: 10.1093/ejcts/ezx028.
We evaluated the operative and long-term outcomes of various approaches for aortic arch repair.
A total of 436 consecutive patients who underwent aortic arch repair from January 2001 to March 2016 in our centre were evaluated. Of these, 276 underwent conventional total arch replacement (TAR), and 118 underwent thoracic endovascular repair (TEVAR). The remaining 42 patients underwent staged thoracic endovascular repair (STEVAR). A total of 72 patients in the TEVAR group were matched to 72 patients who underwent open surgery including TAR or STEVAR by using propensity score analysis.
Surgical outcomes showed shorter ICU and hospital stay in the TEVAR group ( P < 0.001 and P < 0.001, respectively). The 30-day mortality and neurologic dysfunction showed no significant difference among the three groups (2.8 and 5.4% in TAR group, 1.7 and 8.5% in TEVAR group and 0 and 2.4% in STEVAR group; P = 0.500 and P = 0.297, respectively). Long-term survival was not significantly different among the three groups (78% in TAR group, 67% in TEVAR group and 81% in STEVAR group at 5 years; P = 0.123). Freedom from aortic reintervention was lower in the TEVAR group than in other groups (98% in TAR, 92% in TEVAR and 97% in STEVAR at 5 years, P = 0.040).
Operative outcomes showed no significant differences between the groups except for early recovery after TEVAR. Long-term survival was similar between groups; however, TEVAR had inferior reintervention free rate.
我们评估了主动脉弓修复的各种手术方法及其长期疗效。
对2001年1月至2016年3月在本中心接受主动脉弓修复的436例连续患者进行评估。其中，276例行传统全弓置换术（TAR），118例行胸主动脉腔内修复术（TEVAR）。其余42例行分期胸主动脉腔内修复术（STEVAR）。通过倾向评分分析，将TEVAR组中的72例患者与72例接受开放手术（包括TAR或STEVAR）的患者进行匹配。
手术结果显示TEVAR组的ICU住院时间和住院时间较短（分别为P < 0.001和P < 0.001）。三组的30天死亡率和神经功能障碍无显著差异（TAR组为2.8%和5.4%，TEVAR组为1.7%和8.5%，STEVAR组为0和2.4%；P分别为0.500和0.297）。三组的长期生存率无显著差异（5年时TAR组为78%，TEVAR组为67%，STEVAR组为81%；P = 0.123）。TEVAR组主动脉再次干预的自由度低于其他组（5年时TAR组为98%，TEVAR组为92%，STEVAR组为97%，P = 0.040）。
除TEVAR术后早期恢复外，各组手术结果无显著差异。各组长期生存率相似；然而，TEVAR的再次干预自由度较低。
