Department of Cardiac Surgery, Ludwig Maximilian University Munich, Munich, Germany.
Department of Thoracic and Cardiovascular Surgery, Faculty of Medicine, Kepler University Hospital Linz, Johannes Kepler University Linz, Linz, Austria.
Eur J Cardiothorac Surg. 2018 Mar 1;53(3):519-524. doi: 10.1093/ejcts/ezx378.
The true incidence of aortic events (AEs) and reoperations (REDO) following elective total aortic arch replacement remains unknown. The aim of this study was to review the incidence of AEs and surgical REDO, and its respective outcomes after 1232 elective arch repairs at 11 European aortic centres.
Retrospective chart review (in the absence of prospective data collection) was performed for statistical analysis. Follow-up was conducted during routine clinical examination or in a telephone interview with patients and/or their respective physicians.
One hundred fifty-five (12.6%) patients were identified (median follow-up time 48.7 months). The recorded AEs comprised aortic dilatation (62.6%), rupture (15.5%), endoleak (11%), false aneurysm (3.9%), dissection (3.2%), infection (2.6%) and others (1.3%). REDO (open/endovascular) were performed in 85.8% of patients (n = 133). Intraoperative and in-hospital mortality in the REDO patients were 7.5% and 17.3%, respectively. Postoperative neurological complications comprised paraplegia (6.0%) and stroke (1.5%). Survival rates after REDO at 1, 3 and 5 years were 81.2%, 79.0% and 76.7%, respectively. Univariate analysis identified 'rupture' and 'diameter progression', 'older age at REDO' and the REDO strategies 'frozen elephant trunk' and 'no elephant trunk' as predictors of increased in-hospital mortality. Multivariate analysis identified 'older age at REDO' (P = 0.008) as the only independent risk factor for in-hospital mortality.
AEs after elective arch surgery are not irrelevant and mostly involve the distal aspects of the adjoining aorta. In accordance with the underlying pathology, open or endovascular REDO may be performed with an acceptable outcome. Preparation of an adequate proximal landing zone at the time of primary arch surgery is advisable.
择期全主动脉弓置换术后主动脉不良事件（AE）和再次手术（redo）的真实发生率尚不清楚。本研究旨在回顾 11 个欧洲主动脉中心的 1232 例择期弓部修复术后 AE 和外科 redo 的发生率及其各自的结果。
回顾性图表审查（缺乏前瞻性数据收集）进行了统计分析。随访通过常规临床检查或与患者及其各自的医生进行电话访谈进行。
确定了 155 名（12.6%）患者（中位随访时间 48.7 个月）。记录的 AE 包括主动脉扩张（62.6%）、破裂（15.5%）、内漏（11%）、假性动脉瘤（3.9%）、夹层（3.2%）、感染（2.6%）和其他（1.3%）。85.8%的患者（n=133）行 redo（开放/血管内）。redo 患者的术中死亡率和住院死亡率分别为 7.5%和 17.3%。术后神经系统并发症包括截瘫（6.0%）和中风（1.5%）。redo 后 1、3 和 5 年的生存率分别为 81.2%、79.0%和 76.7%。单因素分析确定“破裂”和“直径进展”、“redo 时年龄较大”以及 redo 策略“冷冻象鼻”和“无象鼻”为增加住院死亡率的预测因素。多因素分析确定“redo 时年龄较大”（P=0.008）是住院死亡率的唯一独立危险因素。
择期弓部手术后的 AE 并非无关紧要，且大多涉及毗邻主动脉的远端部位。根据潜在的病理情况，可采用开放或血管内 redo，结果可接受。在初次弓部手术时准备一个合适的近端着陆区是明智的。
