应用冰冻象鼻技术行全弓置换治疗急性A型主动脉夹层的早期及长期疗效
Early and long-term results of total arch replacement with the frozen elephant trunk technique for acute type A aortic dissection.
作者信息
Yoshitake Akihiro, Tochii Masato, Tokunaga Chiho, Hayashi Jun, Takazawa Akitoshi, Yamashita Kentaro, Chubachi Fumiya, Hori Yuuto, Nakajima Hiroyuki, Iguchi Atsushi, Gatate Yodo, Nakano Shintaro, Asakura Toshihisa
机构信息
Department of Cardiovascular Surgery, Saitama Medical University International Medical Center, Saitama, Japan.
Department of Cardiology, Saitama Medical University International Medical Center, Saitama, Japan.
出版信息
Eur J Cardiothorac Surg. 2020 Oct 1;58(4):707-713. doi: 10.1093/ejcts/ezaa099.
OBJECTIVES
We evaluated the operative and long-term outcomes of the frozen elephant trunk (FET) technique for acute type A aortic dissection.
METHODS
This study evaluated 426 consecutive patients who underwent aortic repair for acute type A aortic dissection from June 2007 to December 2018 at our centre. Of these, 139 patients underwent total arch replacement with FET (FET group), and 287 underwent other procedures (no FET group). Ninety-two patients in the FET group were matched to 92 patients in the no FET group by using propensity score matching analysis.
RESULTS
Thirty-day mortality and neurological dysfunction were not significantly different between the FET and no FET groups (1.4% vs 2.4%, P = 0.50 and 5.0% vs 6.3%, P = 0.61, respectively). Long-term survival was better in the FET group than in the no FET group (P = 0.008). Freedom from distal thoracic reintervention was similar in the FET and no FET groups (P = 0.74). In the propensity-matched patients, freedom from aortic-related death was better in the FET group than in the no FET group (P = 0.044).
CONCLUSIONS
Operative outcomes showed no significant difference between the 2 groups. FET contributes to better long-term survival in patients with acute type A aortic dissection.
目的
我们评估了用于急性A型主动脉夹层的冰冻象鼻（FET）技术的手术及长期疗效。
方法
本研究评估了2007年6月至2018年12月在我们中心因急性A型主动脉夹层接受主动脉修复的426例连续患者。其中，139例患者接受了FET全弓置换术（FET组），287例接受了其他手术（非FET组）。通过倾向评分匹配分析，将FET组的92例患者与非FET组的92例患者进行匹配。
结果
FET组和非FET组的30天死亡率和神经功能障碍无显著差异（分别为1.4%对2.4%，P = 0.50；5.0%对6.3%，P = 0.61）。FET组的长期生存率高于非FET组（P = 0.008）。FET组和非FET组的无远端胸段再次干预率相似（P = 0.74）。在倾向评分匹配的患者中，FET组的无主动脉相关死亡率高于非FET组（P = 0.044）。
结论
两组的手术结果无显著差异。FET有助于提高急性A型主动脉夹层患者的长期生存率。
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