Uehara Kyokun, Matsuda Hitoshi, Matsuo Jiro, Inoue Yosuke, Omura Atsushi, Seike Yoshimasa, Sasaki Hiroaki, Kobayashi Junjiro
Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, Suita, Osaka, Japan.
J Card Surg. 2018 Apr;33(4):184-189. doi: 10.1111/jocs.13558. Epub 2018 Mar 13.
To evaluate the surgical outcomes and midterm results of patients under 50 years old with acute type A aortic dissection (AAAD).
The study population included 51 patients who underwent AAAD repair between 2003 and 2016. Of these 51 patients, 46 (90.1%) were males and 14 (27.5%) had connective tissue disorders. Twenty-five patients (49.0%) had a body mass index >25.0 kg/m and two patients were pregnant. Total arch replacement was performed in 39 patients (76.5%) and hemiarch replacement in 12 patients (23.5%). Twenty patients (39.2%) underwent concomitant surgeries, including root replacement, lower limb bypass, or coronary artery bypass grafting.
There was one in-hospital death (2.0%). Median follow-up was 55 months and overall survival rates were 87.7% at 5 years and 81.9% at 10 years. Rates of freedom from reoperation were 60.2% at 5 years and 50.2% at 10 years. Eighteen patients (35.3%) required reoperation, due to progressive aortic dilatation, new dissection in the aortic root, infection, and hemolysis. A patent false lumen represented a significant risk factor for reoperation (P < 0.001). Four patients (7.8%) underwent reoperation within 3 months after the initial repair.
Surgical outcomes after AAAD repair for young patients were satisfactory. A patent false lumen significantly increased the need for reoperation (P = 0.002), but did not affect long-term survival. Close follow-up is mandatory after the initial repair in young patients following AAAD.
评估50岁以下急性A型主动脉夹层（AAAD）患者的手术效果及中期结果。
研究人群包括2003年至2016年间接受AAAD修复手术的51例患者。这51例患者中，46例（90.1%）为男性，14例（27.5%）患有结缔组织疾病。25例患者（49.0%）体重指数>25.0kg/m²，2例患者为孕妇。39例患者（76.5%）进行了全弓置换，12例患者（23.5%）进行了半弓置换。20例患者（39.2%）接受了同期手术，包括根部置换、下肢旁路手术或冠状动脉旁路移植术。
有1例住院死亡（2.0%）。中位随访时间为55个月，5年总生存率为87.7%，10年为81.9%。5年再次手术率为60.2%，10年为50.2%。18例患者（35.3%）因主动脉进行性扩张、主动脉根部新的夹层形成、感染和溶血而需要再次手术。持续性假腔是再次手术的一个重要危险因素（P<0.001）。4例患者（7.8%）在初次修复后3个月内接受了再次手术。
年轻患者AAAD修复术后的手术效果令人满意。持续性假腔显著增加了再次手术的需求（P=0.002），但不影响长期生存。年轻患者初次修复后必须进行密切随访。
