Department of Cardiovascular Surgery, Cardiovascular Clinic Bad Neustadt, Bad Neustadt, Germany.
Department of Thoracic and Cardiovascular Surgery, Johannes Kepler University Hospital, Linz, Austria.
Ann Thorac Surg. 2019 Jul;108(1):115-121. doi: 10.1016/j.athoracsur.2018.12.043. Epub 2019 Jan 25.
The aim of the study was to evaluate operative and long-term results after acute type A aorta dissection (AAAD) operation, in which complete resection of all dissected aortic segments (curative repair) was achieved.
Among 205 consecutive patients operated on between 2002 and 2014 because of AAAD were 88 patients (42.9%), in whom the dissection did not extend into the downstream aorta. The distal extension of the dissection ended before the origin of the innominate artery in 50 patients of the study cohort (56.8%) or extended throughout the arch, necessitating a total/subtotal arch replacement to achieve a curative distal repair in 38 remaining patients (43.2%). The aortic root was involved in 52 patients (59.1%) and was repaired using valve-sparing repair (31) or replacement with a valve composite graft (21). Combination of root and open arch surgery was reported in 46 patients (52.3%).
Thirty-day and in-hospital mortalities were 3.4% and 5.7%, respectively. Survival was estimated starting with the operation and was 81.9% ± 4.5% and 56.6% ± 8.7% at 5 and 10 years, respectively. No patient required reoperation on the aortic root and/or distal thoracoabdominal aorta; however 2 cardiac reoperations were unrelated to the primary surgical procedure. Moreover, the freedom of aortic and/or sudden/unknown death was 100%.
Curative aortic repair can be achieved in a relevant share of AAAD patients and is mostly limited by the distal extension of dissection. This kind of repair is advisable, whenever possible, because it can provide very low risk of aortic complications and/or reoperations over time.
本研究旨在评估急性 A 型主动脉夹层（AAAD）手术的手术和长期结果，其中所有夹层主动脉节段（根治性修复）均被完全切除。
在 2002 年至 2014 年间连续接受手术治疗的 205 例 AAAD 患者中，有 88 例（42.9%）夹层未延伸至下游主动脉。研究队列中的 50 例患者（56.8%）夹层的远端延伸止于无名动脉起点之前，38 例患者（43.2%）夹层延伸贯穿整个主动脉弓，需要进行全/次全弓置换以实现根治性远端修复。52 例患者（59.1%）主动脉根部受累，其中 31 例行保留瓣膜修复，21 例行带瓣复合移植物置换。46 例患者（52.3%）行根部与开放弓部手术联合。
30 天和住院死亡率分别为 3.4%和 5.7%。以手术为起点，生存估计值分别为 81.9%±4.5%和 56.6%±8.7%，随访 5 年和 10 年。无患者因主动脉根部和/或胸降主动脉需要再次手术，但有 2 例心脏再次手术与初次手术无关。此外，主动脉和/或猝死/不明原因死亡的自由度为 100%。
在相当一部分 AAAD 患者中可以实现根治性主动脉修复，而且主要受到夹层远端延伸的限制。只要可能，这种修复是可行的，因为它可以随着时间的推移提供非常低的主动脉并发症和/或再次手术的风险。
