Shimizu Hideyuki, Hirahara Norimichi, Motomura Noboru, Miyata Hiroaki, Takamoto Shinichi
JCVSD, C/O The Japan Society for Cardiovascular Surgery, 2-26-9 Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan.
Department of Cardiovascular Surgery, Keio University, Tokyo, Japan.
Gen Thorac Cardiovasc Surg. 2017 Dec;65(12):671-678. doi: 10.1007/s11748-017-0822-9. Epub 2017 Sep 5.
Although open aortic repair (OAR) is still considered to be a standard treatment for thoracic aortic diseases, the indications for thoracic endovascular treatment (TEVAR)/hybrid aortic repair (HAR) have expanded in recent years. The purpose of this study was to review the current status of treatment of thoracic aortic diseases in Japan.
Data for 2013 and 2014 concerning surgery for diseases of the thoracic/thoracoabdominal aorta were extracted from the Japan Cardiovascular Surgery Database (JCVSD). The number of cases and operative mortality were evaluated in terms of pathologic diagnosis (acute dissection, chronic dissection, ruptured aneurysm, unruptured aneurysm), treatment modality (OAR, HAR, TEVAR), JapanSCORE (JS; <5%, 5-10%, 10-15%, ≥15%), and their correlations.
There were 30,271 total cases in this study and the overall operative mortality was 5.9%. Among the three types of treatment, 73.2% of patients underwent OAR (root 98.3%; ascending 97.4%; root to arch 95.5%; arch 81.7%; descending 34.2%; thoracoabdominal 64.4%). While the rate of OAR was negatively correlated with JS for the treatment of the thoracoabdominal region (JS < 5, 80.4%; 5% ≤ JS < 10, 67.6%; 10% ≤ JS < 15, 58.8%; JS ≥ 15, 55.7%), a correlation was not observed in other anatomic regions. The operative mortality associated with OAR was well reflected by JS (JS < 5, 2.1%; 5% ≤ JS < 10, 5.5%; 10% ≤ JS < 15, 10.2%; JS ≥ 15, 20.3%); however, the operative mortality associated with TEVAR/HAR was less than that with JS.
The distribution of treatment differs depending on the site of disease and is not markedly influenced by JS. It is clear that JS is a reliable tool for estimating operative mortality in OAR. However, the observed operative mortality was lower than the JS in TEVAR/HAR, and a new risk score for TEVAR/HAR should be established.
尽管开放主动脉修复术（OAR）仍被视为胸主动脉疾病的标准治疗方法，但近年来胸主动脉腔内治疗（TEVAR）/杂交主动脉修复术（HAR）的适应证有所扩大。本研究的目的是回顾日本胸主动脉疾病的治疗现状。
从日本心血管外科数据库（JCVSD）中提取2013年和2014年有关胸/胸腹主动脉疾病手术的数据。根据病理诊断（急性夹层、慢性夹层、破裂动脉瘤、未破裂动脉瘤）、治疗方式（OAR、HAR、TEVAR）、日本心血管外科手术风险评分（JapanSCORE，JS；<5%、5 - 10%、10 - 15%、≥15%）及其相关性评估病例数和手术死亡率。
本研究共有30271例病例，总体手术死亡率为5.9%。在三种治疗方式中，73.2%的患者接受了OAR（根部98.3%；升主动脉97.4%；根部至弓部95.5%；弓部81.7%；降主动脉34.2%；胸腹主动脉64.4%）。对于胸腹主动脉区域的治疗，OAR的比例与JS呈负相关（JS < 5，80.4%；5%≤JS < 10，67.6%；10%≤JS < 15，58.8%；JS≥15，55.7%），而在其他解剖区域未观察到相关性。JS能很好地反映与OAR相关的手术死亡率（JS < 5，2.1%；5%≤JS < 10，5.5%；10%≤JS < 15，10.2%；JS≥15，20.3%）；然而，与TEVAR/HAR相关的手术死亡率低于JS。
治疗方式的分布因疾病部位而异，且不受JS的显著影响。显然，JS是评估OAR手术死亡率的可靠工具。然而，观察到的TEVAR/HAR手术死亡率低于JS，因此应建立新的TEVAR/HAR风险评分。
