Ghazy Tamer, Eraqi Mohamed, Mahlmann Adrian, Hegelmann Helena, Matschke Klaus, Kappert Utz, Weiss Norbert
Department of Cardiac Surgery of the Dresden Heart Centre, Dresden University of Technology, Dresden, Germany.
UniversitätsGefäßCentrum, Dresden University of Technology, Dresden, Germany.
Heart Surg Forum. 2017 Jun 22;20(3):E102-E106. doi: 10.1532/hsf.1738.
Outcome of surgery for acute Stanford type A aortic dissection extends beyond mortality and morbidity. More than one operative strategy is available but little is known regarding their influence on quality of life. This study analyzes the influence of defensive and aggressive operative strategies on the patients' midterm quality of life (QoL).
From July 2007 to July 2010, 95 patients underwent surgery for acute Stanford type A aortic dissection in our institution. Patients who survived the procedure, gave consent to inclusion in the institution prospective registry, completed at least 2-years of follow-up protocol, and answered two quality of life questionnaires (SF-36 and WHO-QOL-BREF) were included in the study. Patients were divided into two groups according to operative strategy: defensive (DS) with replacement of the ascending aorta only, and aggressive (AS) with replacement of the ascending aorta, aortic arch with/out a frozen elephant trunk procedure. The preoperative, operative, postoperative and the midterm QoL were analyzed and compared.
39 patients were included in the study. The DS group had a shorter operative time (184 ± 54 versus 276 ± 110 minutes respectively, P = .001). The AS group had higher incidence of dialysis (31% versus 4% respectively, P = .038). The midterm QoL analysis showed a collective lower value than the normal population. In the SF-36, DS performed better in all categories but with no statistical significance. In the WHO-QOL-BREF, DS performed significantly better in the global life quality and psychological health categories (P = .038 and .049 respectively).
In Stanford type A aortic dissection, adopting an aggressive surgical strategy does not improve the quality of life in midterm follow-up compared to a defensive strategy. Unless the clinical setting dictates an aggressive management strategy, a defensive strategy can be safely adopted.
急性 Stanford A 型主动脉夹层手术的结果不仅限于死亡率和发病率。有多种手术策略可供选择，但关于它们对生活质量的影响知之甚少。本研究分析了防御性和积极手术策略对患者中期生活质量（QoL）的影响。
2007 年 7 月至 2010 年 7 月，95 例急性 Stanford A 型主动脉夹层患者在我院接受手术。手术存活、同意纳入机构前瞻性登记、完成至少 2 年随访方案并回答两份生活质量问卷（SF-36 和 WHO-QOL-BREF）的患者纳入研究。根据手术策略将患者分为两组：仅置换升主动脉的防御性（DS）组和置换升主动脉、主动脉弓并伴有或不伴有冰冻象鼻手术的积极（AS）组。对术前、术中、术后及中期生活质量进行分析和比较。
39 例患者纳入研究。DS 组手术时间较短（分别为 184±54 分钟和 276±110 分钟，P = 0.001）。AS 组透析发生率较高（分别为 31%和 4%，P = 0.038）。中期生活质量分析显示总体值低于正常人群。在 SF-36 中，DS 组在所有类别中表现更好，但无统计学意义。在 WHO-QOL-BREF 中，DS 组在总体生活质量和心理健康类别中表现明显更好（分别为 P = 0.038 和 0.049）。
在 Stanford A 型主动脉夹层中，与防御性策略相比，采用积极手术策略在中期随访中并未改善生活质量。除非临床情况决定采用积极的管理策略，否则可以安全地采用防御性策略。
