Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
Cardiovascular Center, Yokohama City University Medical Center, Yokohama, Japan.
J Thorac Cardiovasc Surg. 2021 Oct;162(4):1025-1031. doi: 10.1016/j.jtcvs.2020.02.087. Epub 2020 Mar 7.
The outcomes of emergency surgery for type A acute aortic dissection have improved. However, ascending aortic replacement sometimes leads to dilatation of the distal aorta. The present study reviewed our outcomes of ascending aortic replacement and total arch replacement in patients with type A acute aortic dissection.
A total of 253 patients with type A acute aortic dissection underwent a central repair operation. Our standard technique was ascending aortic replacement. Total arch replacement was performed only when entry existed in the major curvature of the aortic arch and the proximal descending aorta. A total of 169 patients (67%) underwent ascending aortic replacement, and 84 patients (33%) underwent total arch replacement. Hospital death due to initial surgery, dilatation of the distal aorta greater than 5 cm, new occurrence of aortic dissection, any distal aortic surgery, and aortic-related deaths were defined as distal aortic events.
The mortality was 7.1% in the ascending aortic replacement group and 6.0% in the total arch replacement group. Postoperative computed tomography was performed in 162 patients in the ascending aortic replacement group. The false lumen of the residual aortic arch had thrombosed and healed in 94 patients (58%) and remained present in 68 patients (42%). The distal aortic event-free rate in the ascending aortic replacement group decreased from 74% at 5 years to 51% at 9 years, and the rate in the total arch replacement group was 83% at 5 to 9 years (P < .01). For the ascending aortic replacement group, more patients with a dissected arch had a distal aortic event compared with patients with a healed arch (P < .01).
Total arch replacement was associated with fewer distal aortic events. We may expand the indications for total arch replacement in stable patients.
A型急性主动脉夹层的急诊手术结果已得到改善。然而，升主动脉置换有时会导致远端主动脉扩张。本研究回顾了我们在 A 型急性主动脉夹层患者中进行升主动脉置换和全主动脉弓置换的结果。
共有 253 例 A 型急性主动脉夹层患者接受了中央修复手术。我们的标准技术是升主动脉置换。仅当主动脉弓主要弯曲处和近端降主动脉有入口时，才进行全主动脉弓置换。共有 169 例（67%）患者接受了升主动脉置换，84 例（33%）患者接受了全主动脉弓置换。因初始手术导致的院内死亡、远端主动脉扩张超过 5cm、新发生的主动脉夹层、任何远端主动脉手术和与主动脉相关的死亡被定义为远端主动脉事件。
升主动脉置换组的死亡率为 7.1%，全主动脉弓置换组的死亡率为 6.0%。在升主动脉置换组的 162 例患者中进行了术后计算机断层扫描。残留主动脉弓的假腔在 94 例（58%）患者中血栓形成并愈合，在 68 例（42%）患者中仍存在。升主动脉置换组的远端主动脉无事件生存率从 5 年时的 74%下降至 9 年时的 51%，而全主动脉弓置换组的 5 年至 9 年的无事件生存率为 83%（P<.01）。对于升主动脉置换组，与愈合弓患者相比，更多的弓部夹层患者发生了远端主动脉事件（P<.01）。我们可能会扩大稳定患者行全主动脉弓置换的适应证。
全主动脉弓置换与较少的远端主动脉事件相关。我们可能会扩大稳定患者行全主动脉弓置换的适应证。
