Section of Vascular and Endovascular Surgery, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn; Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn.
Minneapolis Heart Institute Foundation, Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minn.
J Vasc Surg. 2022 Feb;75(2):484-494.e1. doi: 10.1016/j.jvs.2021.08.058. Epub 2021 Sep 8.
As part of a multidisciplinary aortic dissection (AD) program, a more comprehensive repair strategy for patients with acute type A aortic dissection (ATAAD) and frequent endografting for suitable patients with type B aortic dissection (ATBAD) was adopted in 2015. The aim of this study was to evaluate the impact of these changes.
This study is a retrospective review of a prospective database containing all patients treated for acute AD between 2003 and 2020. Patients were grouped based on differing repair strategies (pre 2015 vs post 2015). Clinical characteristics, procedural details, and survival data were analyzed.
During this time, 323 patients (210 pre, 113 post) were treated for acute AD at our institution. There were 221 patients with ATAAD (149 pre, 72 post) and 102 patients with ATBAD (61 pre, 41 post). The majority (60%) were males, with a mean age of 65.9 ± 15.2 years. There were no differences in cardiovascular risk factors or demographics between the groups. After 2015, fewer patients with ATAAD underwent medical management alone (15% pre vs 4% post; P = .014), and most that underwent surgical intervention had a total arch or aggressive hemiarch repair (27% pre vs 78% post; P < .001). Seventy-four patients (73%) with ATBAD were treated medically, whereas 28 underwent medical management and endografting (23% pre, 34% post; P = .214). For all patients with AD, 30-day mortality was significantly improved (26% pre vs 10% post; P < .001) especially among patients who underwent ATAAD surgery (23% pre vs 9% post; P = .018). Three-year Kaplan-Meier survival estimates showed survival improvement among patients with ATAAD (Log rank P-value = .019); however, this improvement does not extend to type B dissections or the overall cohort. A survival analysis landmarked to 30 days after initial presentation showed no statistical difference in survival from 30 days to 3 years post-presentation.
A more comprehensive repair strategy in the management of patients with acute AD resulted in improved overall patient outcomes and significantly decreased 30-day mortality, even though more complex repairs were performed. The long-term impact of the changes made to our program remains to be evaluated.
作为多学科主动脉夹层（AD）项目的一部分，我们在 2015 年对急性 A 型主动脉夹层（ATAAD）患者采用了更全面的修复策略，并对适合的 B 型主动脉夹层（ATBAD）患者频繁进行腔内修复。本研究旨在评估这些变化的影响。
本研究回顾性分析了 2003 年至 2020 年间在我院接受急性 AD 治疗的所有患者的前瞻性数据库。根据不同的修复策略（2015 年前 vs. 2015 年后）对患者进行分组。分析了临床特征、手术细节和生存数据。
在此期间，我院共收治 323 例急性 AD 患者（210 例 2015 年前，113 例 2015 年后）。221 例患者为 ATAAD（149 例 2015 年前，72 例 2015 年后），102 例患者为 ATBAD（61 例 2015 年前，41 例 2015 年后）。大多数患者（60%）为男性，平均年龄为 65.9±15.2 岁。两组间心血管危险因素或人口统计学特征无差异。2015 年后，单独接受药物治疗的 ATAAD 患者比例减少（15% 2015 年前 vs. 4% 2015 年后；P=.014），大多数接受手术干预的患者均行全弓或积极的半弓修复（27% 2015 年前 vs. 78% 2015 年后；P<.001）。74 例（73%）ATBAD 患者接受内科治疗，28 例患者接受内科治疗和腔内修复（23% 2015 年前，34% 2015 年后；P=.214）。所有 AD 患者的 30 天死亡率均显著降低（26% 2015 年前 vs. 10% 2015 年后；P<.001），尤其是接受 ATAAD 手术的患者（23% 2015 年前 vs. 9% 2015 年后；P=.018）。3 年 Kaplan-Meier 生存估计显示，ATAAD 患者的生存情况有所改善（Log rank P 值=.019）；然而，这一改善并不能扩展到 B 型夹层或整个队列。以初次就诊后 30 天为标志的生存分析显示，初次就诊后 30 天至 3 年的生存无统计学差异。
在急性 AD 患者的治疗中采用更全面的修复策略，可改善整体患者预后，并显著降低 30 天死亡率，尽管进行了更复杂的修复。我们的治疗方案所做改变的长期影响仍有待评估。
