Qin Wei, Su Cunhua, Li Liangpeng, Carmichael Michael, Huang Fuhua, Chen Xin
Department of Thoracic and Cardiovascular Surgery, Nanjing First Hospital, Nanjing Medical University, 68# Changle Road, Nanjing, Jiangsu, 210006, P.R. China.
J Cardiothorac Surg. 2020 Jul 23;15(1):183. doi: 10.1186/s13019-020-01234-8.
This study compared limited aortic repair (ascending, and /or hemi-arch replacement) versus extended-arch repair (ascending, arch and proximal descending aortic replacement) used for patients aged 65 or older, who had type A acute aortic dissection (AAD), analyzing the influence of the extent of aortic repair on outcomes.
From January, 2001 to December, 2015, 103 patients aged 65 or older underwent operation due to type A AAD in Nanjing First Hospital. The cohort was divided into two subgroups according to the surgical approaches, including limited aortic replacement (LAR, n = 41) and total arch replacement + stent elephant trunk implantation (TAR+SET, n = 62).
There was no significant difference in gender, age, hypertension, diabetes, smoking, PCI history, atrial fibrillation, pericardial effusion, aortic valve insufficiency (≥ moderate), shock situation before operation, and Euro-score II between the two groups except limb malperfusion and tear location. The cross-clamp time, CPB time, intubation time, ICU stay time and hospital time were all significantly less in the LAR group than in the TAR+SET group. A total of 89 patients were discharged home successfully after operation, with a difference of hospital mortality (P = 0.04). The overall survival rates at 5-year follow-up were 82.5 ± 6.0% in LAR group and 75.2 ± 5.6% in TAR+SET group, but with no difference (p = 0.151). The freedom from adverse aortic events at 5-year was 84.3 ± 6.5% in LAR group versus 97.9 ± 2.1% in TAR+SET group, with a statistical difference (p = 0.03).
These findings support limited aortic resection is acceptable for elderly patients with type A AAD if surgical principles allow.
本研究比较了用于65岁及以上急性A型主动脉夹层（AAD）患者的有限主动脉修复术（升主动脉和/或半弓置换）与广泛弓部修复术（升主动脉、主动脉弓和近端降主动脉置换），分析主动脉修复范围对预后的影响。
2001年1月至2015年12月，南京第一医院103例65岁及以上患者因急性A型主动脉夹层接受手术。根据手术方式将队列分为两个亚组，包括有限主动脉置换（LAR，n = 41）和全弓置换+支架象鼻植入术（TAR+SET，n = 62）。
除肢体灌注不良和撕裂部位外，两组在性别、年龄、高血压、糖尿病、吸烟、PCI史、心房颤动、心包积液、主动脉瓣关闭不全（≥中度）、术前休克情况和欧洲心脏手术风险评估系统II评分方面无显著差异。LAR组的主动脉阻断时间、体外循环时间、插管时间、ICU停留时间和住院时间均显著短于TAR+SET组。共有89例患者术后成功出院，医院死亡率存在差异（P = 0.04）。LAR组5年随访的总生存率为82.5±6.0%，TAR+SET组为75.2±5.6%，但无差异（p = 0.151）。LAR组5年无主动脉不良事件生存率为84.3±6.5%，TAR+SET组为97.9±2.1%，有统计学差异（p = 0.03）。
这些研究结果支持，如果手术原则允许，有限主动脉切除术对于老年急性A型主动脉夹层患者是可以接受的。
