Leonard Jeremy R, Lau Christopher, Iannacone Erin M, Gaudino Mario F L, Munjal Monica, Girardi Leonard N
Department of Cardiothoracic Surgery, Weill Cornell Medicine, 525 East 68th St., M-404, New York, NY 10065 USA.
Indian J Thorac Cardiovasc Surg. 2019 Jun;35(Suppl 2):169-173. doi: 10.1007/s12055-018-0691-6. Epub 2018 Aug 15.
Open repair of descending thoracic or thoracoabdominal aortic aneurysm (TAAA) continues to carry a not insignificant operative risk, even in experienced hands. Over the past three decades, there has been considerable improvement in both the mortality and morbidity associated with these procedures. Herein, we describe our operative results and long-term outcomes in patients with chronic type B aortic dissections.
Review of the aortic surgical database was conducted to identify all consecutive patients who underwent repair of TAAA for chronic type B dissection from May 1997 to March 2018. The primary end point was operative mortality with secondary end points as the composite of major adverse events as well as each of the individual complications.
One hundred and fifty-three patients met inclusion criteria with 54.9% (84/153) having surgery on an elective basis. The mean age was 58.9 years with a majority of male gender-107/153 (69.9%). Eighty-three (54.2%) of the TAAA were extent I, while 36 (23.5%) were extent II and 34 (22.3%) extent III-IV. Operative mortality was 8.5% (13/153) with eight of the deaths in patients who presented with extent II TAAA. On Kaplan-Meier survival analysis, 87.5% (95% confidence interval (CI) 77.9-97.1%) of the elective cohort were alive after 5 years while only 69.9% (CI 55.2-84.6%) of those in need of urgent/emergency intervention survived ( = .039).
In a majority of patients with chronic type B dissections, reproducibly, excellent outcomes can be achieved with relatively low risk of mortality. In the higher risk subsets of patients with extent II TAAA, careful consideration and discussion of expected outcomes will help inform the decision-making process.
即使在经验丰富的医生手中，降胸段或胸腹主动脉瘤（TAAA）的开放修复手术仍具有不可忽视的手术风险。在过去三十年中，与这些手术相关的死亡率和发病率都有了显著改善。在此，我们描述了慢性B型主动脉夹层患者的手术结果和长期预后。
回顾主动脉外科数据库，以确定1997年5月至2018年3月期间所有因慢性B型夹层而接受TAAA修复的连续患者。主要终点是手术死亡率，次要终点是主要不良事件的综合指标以及每种个体并发症。
153例患者符合纳入标准，其中54.9%（84/153）为择期手术。平均年龄为58.9岁，大多数为男性——107/153（69.9%）。83例（54.2%）TAAA为I型，36例（23.5%）为II型，34例（22.3%）为III-IV型。手术死亡率为8.5%（13/153），其中8例死亡患者为II型TAAA。根据Kaplan-Meier生存分析，择期手术组5年后87.5%（95%置信区间（CI）77.9-97.1%）存活，而急需紧急干预的患者中只有69.9%（CI 55.2-84.6%）存活（P = 0.039）。
在大多数慢性B型夹层患者中，可重复性地实现良好的预后，且死亡率相对较低。在II型TAAA这类高风险亚组患者中，仔细考虑和讨论预期结果将有助于指导决策过程。
