Spinelli Domenico, Weaver Fred A, Azizzadeh Ali, Magee Gregory A, Piffaretti Gabriele, Benedetto Filippo, Miller Charles C, Sandhu Harleen K, Gable Dennis R, Trimarchi Santi
Unit of Vascular Surgery, Department of Biomedical and Dental Sciences and Morphofunctional Imaging, Policlinico G. Martino, University of Messina, Messina, Italy.
Division of Vascular Surgery and Endovascular Therapy, University of South California, Los Angeles, Calif.
J Thorac Cardiovasc Surg. 2023 Jan;165(1):4-13.e1. doi: 10.1016/j.jtcvs.2021.01.027. Epub 2021 Jan 21.
The study objective was to analyze the outcomes of thoracic endovascular aortic repair performed for complicated and uncomplicated acute type B aortic dissections.
Patients from WL Gore's Global Registry for Endovascular Aortic Treatment who underwent thoracic endovascular aortic repair for acute type B aortic dissections were included, and data were retrospectively analyzed.
Of 5014 patients enrolled in the Global Registry for Endovascular Aortic Treatment, 172 underwent thoracic endovascular aortic repair for acute type B aortic dissections. Of these repairs, 102 were for complicated acute type B aortic dissections and 70 were for uncomplicated acute type B aortic dissections. There were 46 (45.1%) procedures related to aortic branch vessels versus 15 (21.4%) in complicated type B aortic dissections and uncomplicated type B aortic dissections (P = .002). The mean length of stay was 14.3 ± 10.6 days (median, 11; range, 2-75) versus 9.8 ± 7.9 days (median, 8; range, 0-42) in those with complicated type B aortic dissections versus those with uncomplicated acute type B aortic dissections (P < .001). Thirty-day mortality was not different between groups (complicated type B aortic dissections 2.9% vs uncomplicated acute type B aortic dissections 1.4%, P = .647), as well as aortic complications (8.8% vs 5.7%, P = .449). Aortic event-free survival was 62.9% ± 37.1% versus 70.6% ± 29.3% at 3 years (P = .696).
In the Global Registry for Endovascular Aortic Treatment, thoracic endovascular aortic repair results for complicated type B aortic dissections versus uncomplicated acute type B aortic dissections showed that 30-day mortality and perioperative complications were equally low for both. The midterm outcome was positive. These data confirm that thoracic endovascular aortic repair as the first-line strategy for treating complicated type B dissections is associated with a low risk of complications. Further studies with longer follow-up are necessary to define the role of thoracic endovascular aortic repair in uncomplicated acute type B dissections compared with medical therapy. However, in the absence of level A evidence from randomized trials, results of the uncomplicated acute type B aortic dissection patient cohort treated with thoracic endovascular aortic repair from registries are important to understand the related risk and benefit.
本研究的目的是分析针对复杂性和非复杂性急性B型主动脉夹层进行的胸主动脉腔内修复术的结果。
纳入来自WL Gore全球主动脉腔内治疗注册研究中因急性B型主动脉夹层接受胸主动脉腔内修复术的患者，并对数据进行回顾性分析。
在全球主动脉腔内治疗注册研究纳入的5014例患者中，172例因急性B型主动脉夹层接受了胸主动脉腔内修复术。在这些修复手术中，102例针对复杂性急性B型主动脉夹层，70例针对非复杂性急性B型主动脉夹层。与主动脉分支血管相关的手术有46例（45.1%），而在复杂性B型主动脉夹层和非复杂性B型主动脉夹层中分别为15例（21.4%）（P = 0.002）。复杂性B型主动脉夹层患者的平均住院时间为14.3±10.6天（中位数为11天；范围为2 - 75天），而非复杂性急性B型主动脉夹层患者为9.8±7.9天（中位数为8天；范围为0 - 42天）（P < 0.001）。两组间30天死亡率无差异（复杂性B型主动脉夹层为2.9%，非复杂性急性B型主动脉夹层为1.4%，P = 0.647），主动脉并发症发生率也无差异（8.8%对5.7%，P = 0.449）。3年时无主动脉事件生存率在复杂性B型主动脉夹层中为62.9%±37.1%，在非复杂性B型主动脉夹层中为70.6%±29.3%（P = 0.696）。
在全球主动脉腔内治疗注册研究中，针对复杂性B型主动脉夹层与非复杂性急性B型主动脉夹层的胸主动脉腔内修复术结果显示，两者的30天死亡率和围手术期并发症发生率均较低。中期结果是积极的。这些数据证实，胸主动脉腔内修复术作为治疗复杂性B型夹层的一线策略，并发症风险较低。需要进行更长时间随访的进一步研究，以确定胸主动脉腔内修复术与药物治疗相比在非复杂性急性B型夹层中的作用。然而，在缺乏随机试验A级证据的情况下，注册研究中接受胸主动脉腔内修复术的非复杂性急性B型主动脉夹层患者队列的结果对于了解相关风险和益处很重要。
