Belov Yu V, Charchyan E R, Breshenkov D G, Akselrod B A, Eremenko A A, Markin A V, Panov A V, Goryagin A O, Nikonova T A
Petrovsky Russian Scientific Center of Surgery, Moscow, Russia.
Khirurgiia (Mosk). 2021(6. Vyp. 2):15-25. doi: 10.17116/hirurgia202106215.
To present our experience in the treatment of severe patients with mega aorta syndrome.
There were 49 patients with mega aorta syndrome for the period from May 2015 to March 2021. All patients underwent total aortic replacement from sinotubular junction (with staged aortic root repair, if necessary) to abdominal aorta bifurcation. All surgeries were elective. All patients were divided into two groups: group I (=33; 67.3%) - staged replacement, group II (=16; 32.7%) - one-staged replacement of the aorta via thoracophrenolumbotomy. The primary endpoints were mortality, perioperative parameters and complications. We also analyzed long-term freedom from aortic redo surgery and survival rate.
Both groups were comparable by pre-, intra- and postoperative parameters. The interval between surgeries for staged approach was 7.1±2.3 months. Rehabilitation time considering two stages was longer in group I (13±2 vs. 5.5±1.1 months, =0.0001). Between-stage mortality rate was 12% (=4). Intraoperative mortality was absent in both groups. In-hospital mortality was 3% and 12% (=0.25), overall mortality with between-stage interval - 10.2% and 12% (=1.000), respectively. The follow-up period was similar (18±22.7 (range 1-71) and 23.3±19.1 (range 1-51) months, respectively (=0.63)). In group I, 1-year, 3-year and 5-year survival rate considering between-stage mortality was 89% (95% CI 78-100%), 77.1% (95% CI 60.1-98.8%), 77.1% (95% CI 60.1-98.8%), respectively. In group II, 1-year and 3-year survival rate was 86.5% (95% CI 70.5-100%), =0.88. Overall freedom from redo surgery was 92.9% (95% CI 80.3-100%) vs. 90.9% (95% CI 75.4-100%), =0.072.
One-stage total aortic replacement via thoracophrenolumbotomy is safe surgical treatment for mega aorta syndrome, especially in young patients with low surgical risk. Favorable outcomes may be expected in specialized centers with extensive experience in aortic surgery. Compared to staged approach, total aortic replacement eliminates the risks of between-stage aortic rupture. Therefore, it is a worthy alternative to other methods.
介绍我们治疗巨主动脉综合征重症患者的经验。
2015年5月至2021年3月期间有49例巨主动脉综合征患者。所有患者均接受了从窦管交界（必要时行分期主动脉根部修复）至腹主动脉分叉的全主动脉置换术。所有手术均为择期手术。所有患者分为两组：I组（=33例；67.3%）——分期置换，II组（=16例；32.7%）——经胸腰联合切口一期置换主动脉。主要终点为死亡率、围手术期参数和并发症。我们还分析了主动脉再次手术的长期无发生率和生存率。
两组在术前、术中和术后参数方面具有可比性。分期手术的间隔时间为7.1±2.3个月。I组考虑两个阶段的康复时间较长（13±2 vs. 5.5±1.1个月，P=0.0001）。阶段间死亡率为12%（=4例）。两组均无术中死亡。住院死亡率分别为3%和12%（P=0.25），考虑阶段间隔的总死亡率分别为10.2%和12%（P=1.000）。随访期相似（分别为18±22.7（范围1 - 71）和23.3±19.1（范围1 - 51）个月，P=0.63）。在I组中，考虑阶段间死亡率的1年、3年和5年生存率分别为89%（95%CI 78 - 100%）、77.1%（95%CI 60.1 - 98.8%）、77.1%（95%CI 60.1 - 98.8%）。在II组中，1年和3年生存率为86.5%（95%CI 70.5 - 100%），P=0.88。再次手术的总体无发生率为92.9%（95%CI 80.3 - 100%）对90.9%（95%CI 75.4 - 100%），P=0.072。
经胸腰联合切口一期全主动脉置换术是治疗巨主动脉综合征的安全手术方法，尤其适用于手术风险低的年轻患者。在有丰富主动脉手术经验的专业中心有望获得良好结果。与分期手术相比，全主动脉置换消除了阶段间主动脉破裂的风险。因此，它是其他方法的一个有价值的替代方案。
