Özçınar Evren, Çakıcı Mehmet, Baran Çağdaş, Gümüş Fatih, Özgür Alper, Yazıcıoğlu Levent, Kaya Bülent, Akar Ahmet Rüçhan
Department of Cardiovascular Surgery, Medical Faculty of Ankara University, Ankara, Turkey.
Turk Gogus Kalp Damar Cerrahisi Derg. 2018 Jan 9;26(1):1-7. doi: 10.5606/tgkdc.dergisi.2018.14683. eCollection 2018 Jan.
This study aims to evaluate the results of late-onset type A aortic dissection following primary cardiac surgery and to compare the outcomes of patients with or without prior coronary artery bypass grafting.
Between January 2005 and December 2015, data of 32 patients (16 males, 16 females; mean age 58.1±10.9 years; range, 45 to 73 years) who were diagnosed with acute type A aortic dissection and underwent repair with a history of previous cardiac surgery at our institution were retrospectively analyzed. The patients were divided into two groups as those with a history of prior coronary artery bypass grafting (n=16) and the patients with a previous cardiac surgery without prior coronary artery bypass grafting (n=16).
Dissection of the ascending aorta occurred in 32 patients (late acute in 22 and late chronic in 10) who underwent previous cardiac surgery (aortic valve replacement in 12, mitral valve replacement in two, aortic valve replacement + coronary artery bypass grafting in two, coronary artery bypass grafting in 10, mitral valve replacement + coronary artery bypass grafting in four, and dual valve replacement in two patients). The mean time between the first operation and dissection was 4.0±1.5 years. Dissections were treated with the Bentall procedures (n=8), ascending aorta replacement (n=14), ascending aorta replacement + hemiarch replacement (n=4), ascending aorta + aortic valve replacement (n=4) and Bentall + arch replacement (n=2). In-hospital mortality (30-day mortality) was seen in five patients, and oneyear mortality rate was 21.85% (n=7). The survival rates of the all patients for primary cardiac surgery vs primary cardiac surgery + coronary artery bypass grafting were 81.25% vs 75% at one year, 75% vs 68.75% at three years,75% vs 56.25% at five years, 68.75% vs 56.25% at seven years, and 68.75% vs 56.25% at 10 years, respectively (p=0.71, CI: 95%).
Type-A aortic dissections may develop after cardiac operations with or without coronary artery bypass grafting at any time, and irrespective of associated histologies, they may result in high overall in-hospital mortality. With careful planning by prompt intervention, the outcomes in redo sternotomy operations with or without coronary artery bypass grafting for aortic dissections would be consistent the results of spontaneous aortic dissections.
本研究旨在评估初次心脏手术后迟发性A型主动脉夹层的结果，并比较有或无冠状动脉旁路移植术史患者的预后。
回顾性分析2005年1月至2015年12月期间在我院诊断为急性A型主动脉夹层并接受修复且有既往心脏手术史的32例患者（男16例，女16例；平均年龄58.1±10.9岁；范围45至73岁）的数据。患者分为两组，一组有冠状动脉旁路移植术史（n = 16），另一组有既往心脏手术史但无冠状动脉旁路移植术史（n = 16）。
32例曾接受心脏手术的患者发生升主动脉夹层（22例为迟发性急性夹层，10例为迟发性慢性夹层）（12例行主动脉瓣置换术，2例行二尖瓣置换术，2例行主动脉瓣置换术+冠状动脉旁路移植术，10例行冠状动脉旁路移植术，4例行二尖瓣置换术+冠状动脉旁路移植术，2例行双瓣置换术）。首次手术与夹层发生之间的平均时间为4.0±1.5年。夹层采用Bentall手术治疗（n = 8）、升主动脉置换术（n = 14）、升主动脉置换术+半弓置换术（n = 4）、升主动脉+主动脉瓣置换术（n = 4）和Bentall+弓置换术（n = 2）。5例患者出现院内死亡（30天死亡率），1年死亡率为21.85%（n = 7）。初次心脏手术患者与初次心脏手术+冠状动脉旁路移植术患者的1年生存率分别为81.25%对75%、3年生存率分别为75%对68.75%、5年生存率分别为75%对56.25%、7年生存率分别为68.75%对56.25%、10年生存率分别为68.75%对56.25%（p = 0.71，CI：95%）。
无论有无冠状动脉旁路移植术，心脏手术后任何时候都可能发生A型主动脉夹层，且无论相关组织学情况如何，都可能导致较高的总体院内死亡率。通过及时干预进行仔细规划，有或无冠状动脉旁路移植术的主动脉夹层再次开胸手术的结果将与自发性主动脉夹层的结果一致。
