Carino Davide, Erben Young, Zafar Mohammad A, Singh Mrinal, Brownstein Adam J, Tranquilli Maryann, Rizzo John, Ziganshin Bulat A, Elefteriades John A
Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, Connecticut.
Department of Vascular Surgery, Yale University School of Medicine, New Haven, Connecticut.
Int J Angiol. 2018 Jun;27(2):114-120. doi: 10.1055/s-0038-1649517. Epub 2018 May 23.
Despite much progress in the surgical and endovascular treatment of thoracoabdominal aortic diseases (TAADs), there is no consensus regarding the optimal approach to minimize operative mortality and end-organ dysfunction. We report our experience in the past 16 years treating TAAD by open surgery. A retrospective review of all TAAD patients who underwent an open repair since January 2000 was performed. The primary endpoints included early morbidity and mortality, and the secondary endpoints were overall death and rate of aortic reintervention. There were 112 patients treated by open surgery for TAAD. Mean age was 66 ± 10 years and 61 (54%) were male. Seventy-seven (69%) patients had aneurysmal degeneration without aortic dissection and the remaining 35 (31%) had a concomitant aortic dissection. There were 12 deaths (10.7%) and they were equally distributed between the aneurysm and dissection groups ( = 0.8). The mortality for elective surgery was 3.2% (2/61). The rate of permanent paraplegia and stroke were each 2.6% (3/112). The rate of cerebrovascular accident was significantly higher in the dissection group (8.5% vs. 1.2%, = 0.05). The survival at 1, 5, and 10 years was 80.6, 56.1, and 32.7%, respectively. Our data confirm that open replacement of the thoracoabdominal aorta can be performed in expert centers quite safely. Different aortic pathologies (degenerative aneurysm vs. dissection) do not influence the short- and long-term outcomes. Open surgery should still be considered the standard in the management of TAAD.
尽管胸腹主动脉疾病（TAADs）的外科手术和血管内治疗取得了很大进展，但对于将手术死亡率和终末器官功能障碍降至最低的最佳方法尚无共识。我们报告过去16年通过开放手术治疗TAAD的经验。
对2000年1月以来接受开放修复的所有TAAD患者进行了回顾性研究。主要终点包括早期发病率和死亡率，次要终点是总体死亡和主动脉再次干预率。
有112例患者接受了TAAD的开放手术治疗。平均年龄为66±10岁，61例（54%）为男性。77例（69%）患者有动脉瘤样退变但无主动脉夹层，其余35例（31%）伴有主动脉夹层。有12例死亡（10.7%），在动脉瘤组和夹层组中分布均匀（P = 0.8）。择期手术的死亡率为3.2%（2/61）。永久性截瘫和卒中的发生率均为2.6%（3/112）。夹层组的脑血管意外发生率显著更高（8.5%对1.2%，P = 0.05）。1年、5年和10年的生存率分别为80.6%、56.1%和32.7%。
我们的数据证实了在专业中心可以相当安全地进行胸腹主动脉的开放置换。不同的主动脉病变（退行性动脉瘤与夹层）不影响短期和长期结果。开放手术仍应被视为TAAD治疗的标准方法。
