Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
International Aortic Arch Surgery Study Group, Macquarie Park, Australia.
Ann Thorac Surg. 2019 Aug;108(2):452-457. doi: 10.1016/j.athoracsur.2019.01.064. Epub 2019 Mar 7.
During elective aortic arch replacement, the addition of an aortic root procedure has an unknown effect on morbidity and mortality. The purpose of this study is to determine the effect of adding an aortic root procedure to elective aortic surgery using the ARCH international database.
The ARCH Database was queried for all elective aortic arch replacements with and without aortic root replacement using moderate hypothermic circulatory arrest and antegrade cerebral perfusion from 2000 to 2015. Propensity score matching analysis was used to balance covariates, and a logistic regression model was created.
A total of 1,169 patients were included for analysis, and 320 patients (27.4%) underwent an aortic root procedure. Patients undergoing root procedures were younger (69 versus 61 years), had less coronary artery disease (20% versus 32%), and had a higher incidence of Marfan's syndrome (4.2% versus 10.0%) (p < 0.001 for all). Concomitant coronary artery bypass grafting (26.6% versus 19.7%), total aortic arch replacement (41.6% versus 84.3%), and elephant trunk procedures (46% versus 17.2%) were performed more frequently in the nonroot cohort (p < 0.001 for all). Cardiopulmonary bypass and aortic cross-clamp times were significantly longer in the cohort of patients who underwent root procedures, whereas cerebral perfusion times were longer in the nonroot cohort (p < 0.001 for all). In both the propensity matched and nonmatched analyses, postoperative outcomes were not significantly different between patients who underwent root procedures and patients who did not (p > 0.05 for all outcomes). Multivariable logistic regression analyses showed no difference in mortality rates (odds ratio 0.62, 95% confidence interval: 0.9 to 1.34, p = 0.22) or in rates of permanent stroke (odds ratio 0.89, 95% confidence interval: 0.36 to 2.24, p = 0.81) between the root and nonroot cohorts.
The addition of an aortic root procedure during elective aortic arch surgery lengthens cardiopulmonary bypass and aortic cross-clamp times but does not increase postoperative morbidity or mortality.
在择期主动脉弓置换术中，附加主动脉根部手术对发病率和死亡率的影响尚不清楚。本研究的目的是使用 ARCH 国际数据库确定在择期主动脉手术中附加主动脉根部手术的效果。
2000 年至 2015 年，使用中度低温体外循环和顺行性脑灌注，在 ARCH 数据库中查询所有行择期主动脉弓置换术且行或不行主动脉根部置换术的患者。使用倾向评分匹配分析来平衡协变量，并创建逻辑回归模型。
共纳入 1169 例患者进行分析，其中 320 例（27.4%）行主动脉根部手术。行根部手术的患者年龄较小（69 岁比 61 岁），冠心病发生率较低（20%比 32%），马凡综合征发生率较高（4.2%比 10.0%）（均<0.001）。同期行冠状动脉旁路移植术（26.6%比 19.7%）、全主动脉弓置换术（41.6%比 84.3%）和象鼻手术（46%比 17.2%）在非根部组中更常见（均<0.001）。行根部手术的患者体外循环和主动脉阻断时间明显延长，而非根部组患者脑灌注时间较长（均<0.001）。在倾向评分匹配和非匹配分析中，行根部手术的患者与未行根部手术的患者术后结局均无显著差异（所有结局的 P>0.05）。多变量逻辑回归分析显示，两组患者死亡率（比值比 0.62，95%置信区间：0.9 至 1.34，P=0.22）或永久性脑卒中发生率（比值比 0.89，95%置信区间：0.36 至 2.24，P=0.81）均无差异。
在择期主动脉弓手术中附加主动脉根部手术虽然延长了体外循环和主动脉阻断时间，但不会增加术后发病率或死亡率。
