Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
Department of Cardiovascular Surgery, Shiga University of Medical Science, Shiga, Japan.
Ann Thorac Surg. 2018 Jul;106(1):63-69. doi: 10.1016/j.athoracsur.2018.01.071. Epub 2018 Mar 1.
It is impossible to resolve all the problems of the entire diseased aorta with just one operation for acute type A aortic dissection, which requires additional surgical treatment in the long-term.
From April 2004 to March 2017, 310 patients underwent surgical repair for acute type A aortic dissection at our institution. Of these, 32 (10.3%) died in the hospital. Of the 278 hospital survivors, 38 underwent late reoperation associated with aortic dissection during the follow-up period. We compared the 240 nonreoperation patients and the 38 reoperation patients to analyze risk factors for late reoperation after operations for acute type A dissection.
The mean duration from the initial operation to reoperation was 3.54 ± 3.0 years. The rates of actuarial freedom from reoperation were 96.9%, 83.2%, and 64.2% at 1, 5, and 10 years, respectively. The multivariate Cox proportional hazard regression analysis revealed the following as independent predictors of late reoperation: younger age, Marfan syndrome, nonprescription of β-blockers, greater diameter of the descending aorta, ratio of false lumen to true lumen of more than 1, limb malperfusion, and primary entry in the ascending aorta. Log-rank analysis revealed no difference in long-term survival between the two groups.
We found several risk factors for both late reoperation and death. Specifically, aortic diameter in the early phase after the initial operation and nonuse of β-blockers were strong predictors. The ratio of the false lumen to the true lumen may also be a new and useful indicator for late reoperation.
对于急性 A 型主动脉夹层，一次手术不可能解决整个病变主动脉的所有问题，长期来看还需要额外的手术治疗。
自 2004 年 4 月至 2017 年 3 月，我院共对 310 例急性 A 型主动脉夹层患者进行了手术修复。其中 32 例（10.3%）在院内死亡。278 例院内存活患者中，38 例在随访期间因主动脉夹层行晚期再次手术。我们比较了 240 例未再次手术患者和 38 例再次手术患者，分析急性 A 型主动脉夹层手术后晚期再次手术的危险因素。
首次手术后至再次手术的平均时间为 3.54±3.0 年。 actuarial 无再次手术率分别为 96.9%、83.2%和 64.2%，随访 1、5 和 10 年。多变量 Cox 比例风险回归分析显示，以下因素是晚期再次手术的独立预测因素：年龄较小、马凡综合征、未处方β受体阻滞剂、降主动脉直径较大、真假腔比大于 1、肢体灌注不良和升主动脉原发性入口。对数秩分析显示两组患者的长期生存率无差异。
我们发现了晚期再次手术和死亡的几个危险因素。具体来说，首次手术后早期的主动脉直径和未使用β受体阻滞剂是强有力的预测因素。真假腔比也可能是晚期再次手术的一个新的有用指标。
