Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Department of Cardiovascular Surgery, Texas Heart Institute, Houston, TX, USA.
Eur J Cardiothorac Surg. 2018 Sep 1;54(3):510-516. doi: 10.1093/ejcts/ezy039.
To compare short-term outcomes, long-term survival and reinterventions in patients requiring surgery after chronic Type I and chronic primary Type III aortic dissections.
Over an 11-year period, 466 patients underwent thoraco-abdominal aortic aneurysm repair for chronic Type III (n = 239) and Type I (n = 227) aortic dissections. Short-term outcomes and reinterventions were evaluated by multivariable regression analysis for the entire group; propensity matching produced 169 pairs.
Mortality was 6% (n = 28) in the overall cohort and 6.2% (n = 14) and 5.9% (n = 14) in those with chronic Type I and Type III aortic dissections, respectively. Overall stroke and persistent spinal cord deficit rates were 4.0% and 2.6%, respectively, in the Type I group and 1.3% and 3.8% in the Type III group. In the propensity-matched patients, analysis showed no neurological differences between the 2 groups, but respiratory failure was significantly more frequent in the chronic Type I group (30.2% vs 15.4%; P = 0.001). Multivariable analysis identified chronic Type I dissection as an independent risk factor for postoperative pulmonary complications (odds ratio 1.612; 95% confidence interval 1.060-2.452; P = 0.026) and an association between chronic Type I dissection and stroke (odds ratio 4.013; 95% confidence interval 1.026-15.698; P = 0.046). Six-year survival was 74.4% ± 4.1% and 74.4% ± 4.6% in the chronic Type I and Type III groups, respectively (P = 0.87).
Short- and long-term mortality and reintervention rates were comparable after open repair for chronic Type I and primary chronic Type III aortic dissections. Respiratory failure was more frequent in the chronic Type I aortic dissection group.
比较慢性 I 型和原发性慢性 III 型主动脉夹层患者手术后的短期结果、长期生存和再干预。
在 11 年期间，466 例慢性 III 型（n=239）和 I 型（n=227）主动脉夹层患者接受了胸腹主动脉瘤修复。通过多变量回归分析评估整个队列的短期结果和再干预；采用倾向匹配产生 169 对。
总体死亡率为 6%（n=28），慢性 I 型和 III 型主动脉夹层患者的死亡率分别为 6.2%（n=14）和 5.9%（n=14）。I 型组的总体卒中发生率和持续性脊髓缺损发生率分别为 4.0%和 2.6%，III 型组分别为 1.3%和 3.8%。在倾向匹配的患者中，分析显示两组之间没有神经学差异，但慢性 I 型组的呼吸衰竭发生率明显更高（30.2%比 15.4%；P=0.001）。多变量分析确定慢性 I 型夹层是术后肺部并发症的独立危险因素（优势比 1.612；95%置信区间 1.060-2.452；P=0.026），慢性 I 型夹层与卒中之间存在关联（优势比 4.013；95%置信区间 1.026-15.698；P=0.046）。慢性 I 型和 III 型组的 6 年生存率分别为 74.4%±4.1%和 74.4%±4.6%（P=0.87）。
慢性 I 型和原发性慢性 III 型主动脉夹层患者行开放修复后的短期和长期死亡率和再干预率相当。慢性 I 型主动脉夹层组的呼吸衰竭更为常见。
