Department of Cardiovascular Surgery, Shanghai Chest Hospital, Shanghai Jiao Tong University, Shanghai, China.
Department of Cardiac Surgery, Shanghai Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai, China.
Ann Thorac Surg. 2021 Jul;112(1):83-90. doi: 10.1016/j.athoracsur.2020.08.031. Epub 2020 Oct 21.
The clinical predictors of distal aortic remodeling (DAR) after various procedures for extensive acute aortic dissection are not fully understood.
From 2008 to 2018, a total of 122 candidates with extensive acute type A and B aortic dissections survived operations of total arch replacement plus frozen elephant trunk (n = 36), ascending aortic replacement plus supraaortic debranching plus retrograde stenting (hybrid procedure; n = 25), and total endovascular repair (n = 61). We assessed DAR at 4 thoracoabdominal aortic levels based on true lumen expansion, false lumen patency, maximal aortic area, and the blood supply of major branches. Univariate and multivariate logistic and mixed-effect models were performed to delineate patterns and risks for DAR at midterm follow-up.
At 3.9 years, 13 aorta-related adverse events (10.7%; including 3 aortic-related deaths [2.5%]) and 8 aortic reinterventions (6.6%) occurred. Follow-up computed tomography angiography was performed in all patients at 3.3 years (interquartile range, 2.7-4.4 years). The degree of DAR, which was relatively independent among aortic levels, was maximal at the pulmonary bifurcation level (90.2% complete false lumen thrombosis) and decreased along the distal aorta. Analyses of longitudinal data indicated that baseline overall false lumen patency was the only available factor to predict DAR at all 4 aortic levels. Dissection type, surgical technique, implant size, and medication did not sufficiently influence DAR at midterm follow-up.
After distinct operations for extensive acute aortic dissection, DAR beyond the stent graft coverage is a local anatomical behavior independent of dissection type or proximal management.
广泛急性主动脉夹层（acute aortic dissection，AAD）各种手术后远端主动脉重塑（distal aortic remodeling，DAR）的临床预测因素尚不完全清楚。
2008 年至 2018 年，共有 122 名广泛急性 A 型和 B 型主动脉夹层患者在接受全主动脉弓置换加冷冻象鼻（n=36）、升主动脉置换加主动脉弓去分支加逆行支架置入（杂交手术；n=25）和全腔内修复（n=61）手术后幸存。我们根据真腔扩张、假腔通畅、最大主动脉面积和主要分支血供评估了 4 个胸腹主动脉水平的 DAR。采用单因素和多因素逻辑回归和混合效应模型来描述中期随访时 DAR 的模式和风险。
3.9 年后，13 例主动脉相关不良事件（10.7%；包括 3 例主动脉相关死亡[2.5%]）和 8 例主动脉再介入（6.6%）发生。所有患者均在 3.3 年（四分位距 2.7-4.4 年）进行了随访 CT 血管造影。DAR 程度在各个主动脉水平相对独立，在肺动脉分叉水平最大（90.2%完全假腔血栓形成），并沿远端主动脉逐渐下降。纵向数据分析表明，基线总假腔通畅是预测所有 4 个主动脉水平 DAR 的唯一可用因素。夹层类型、手术技术、植入物大小和药物治疗在中期随访中并没有充分影响 DAR。
在广泛急性主动脉夹层的不同手术后，支架移植物覆盖范围以外的 DAR 是一种独立于夹层类型或近端管理的局部解剖学行为。
