Tampere University Heart Hospital, Tampere University, Tampere, Finland; Tampere University, Tampere, Finland.
Karolinska University Hospital, Stockholm, Sweden.
Ann Thorac Surg. 2022 Aug;114(2):492-501. doi: 10.1016/j.athoracsur.2021.09.067. Epub 2021 Nov 10.
The outcome in patients after surgery for acute type A aortic dissection without replacement of the part of the aorta containing the primary tear is undefined.
Data of 1122 patients who underwent surgery for acute type A aortic dissection in 8 Nordic centers from January 2005 to December 2014 were retrospectively analyzed. The patients with primary tear location unfound, unknown, not confirmed, or not recorded (n = 243, 21.7%) were excluded from the analysis. The patients were divided into 2 groups according to whether the aortic reconstruction encompassed the portion of the primary tear (tear resected [TR] group, n = 730) or not (tear not resected [TNR] group, n = 149). The restricted mean survival time ratios adjusted for patient characteristics and surgical details between the groups were calculated for all-cause mortality and aortic reoperation-free survival. The median follow-up time was 2.57 (interquartile range, 0.53-5.30) years.
For the majority of the patients in the TR group, the primary tear was located in the ascending aorta (83.6%). The reconstruction encompassed both the aortic root and the aortic arch in 7.4% in the TR group as compared with 0.7% in the TNR patients (P < .001). There were no significant differences in all-cause mortality (adjusted restricted mean survival time ratio, 1.01; 95% confidence interval, 0.92-1.12; P = .799) or reoperation-free survival (adjusted restricted mean survival time ratio, 0.98; 95% confidence interval, 0.95-1.02; P = .436) between the TR and TNR groups.
Primary tear resection alone does not determine the midterm outcome after surgery for acute type A aortic dissection.
对于未置换包含原发撕裂部位的升主动脉的急性 A 型主动脉夹层患者，其术后结局尚不清楚。
回顾性分析了 2005 年 1 月至 2014 年 12 月期间，8 个北欧中心接受急性 A 型主动脉夹层手术的 1122 例患者的数据。对原发撕裂位置未发现、未知、未确认或未记录的患者（n=243，21.7%）进行了排除分析。根据主动脉重建是否包含原发撕裂部位，将患者分为两组：撕裂切除组（TR 组，n=730）和未切除撕裂组（TNR 组，n=149）。分别计算两组间全因死亡率和主动脉再次手术无失败生存率的经患者特征和手术细节调整的限制平均生存时间比。中位随访时间为 2.57 年（四分位间距，0.53-5.30）。
TR 组中大多数患者的原发撕裂位于升主动脉（83.6%）。TR 组中有 7.4%的患者同时重建了主动脉根部和主动脉弓，而 TNR 组中仅有 0.7%的患者（P<0.001）。TR 组和 TNR 组之间的全因死亡率（经调整的限制平均生存时间比，1.01；95%置信区间，0.92-1.12；P=0.799）或主动脉再次手术无失败生存率（经调整的限制平均生存时间比，0.98；95%置信区间，0.95-1.02；P=0.436）均无显著差异。
单纯切除原发撕裂并不能决定急性 A 型主动脉夹层手术后的中期结局。
