Cardiothoracic Department, Division of Cardiac Surgery, University Hospital of Udine, 33100 Udine, Italy.
Cardiothoracic Department, Division of Cardiology, University Hospital of Udine, 33100 Udine, Italy.
Medicina (Kaunas). 2021 Oct 24;57(11):1155. doi: 10.3390/medicina57111155.
We reviewed a single-institution experience to verify the impact of surgery during different time intervals on early and late results in the treatment of patients with type A acute aortic dissection (A-AAD). : From 2004 to 2021, a total of 258 patients underwent repair of A-AAD; patients were equally distributed among three periods: 2004-2010 (Era 1, = 90), 2011-2016 (Era 2, = 87), and 2017-2021 (Era 3, = 81). The primary end-point was to assess whether through the years changes in indications, surgical strategies and techniques and increasing experience have influenced early and late outcomes of A-AAD repair. : Axillary artery cannulation was almost routinely used in Eras 2 (86%) and 3 (91%) while one femoral artery was mainly cannulated in Era 1 (91%) ( < 0.01). Retrograde cerebral perfusion was predominantly used in Era 1 (60%) while antegrade cerebral perfusion was preferred in Eras 2 (94%,) and 3 (100%); ( < 0.01). There was a significant increase of arch replacement procedures from Era 1 (11%) to Eras 2 (33%) and 3 (48%) ( < 0.01). A frozen elephant trunk was mainly performed in Era 3. Hospital mortality was 13% in Era 1, 11% in Era 2, and 4% in Era 3 ( = 0.07). Actuarial survival at 3 years is 74%, in Era 1, 78% in Era 2, and 89% in Era 3 ( = 0.05). : With increasing experience and a more aggressive approach, including total arch replacement, repair of A-AAD can be performed with low operative mortality in many patients. Patient care and treatment by a specific team organization allows a faster diagnosis and referral for surgery allowing to further improve early and late outcomes.
我们回顾了单中心经验，以验证在不同时间段进行手术对治疗 A 型急性主动脉夹层（A-AAD）患者的早期和晚期结果的影响。2004 年至 2021 年，共有 258 例 A-AAD 患者接受了修复手术；患者在三个时期平均分布：2004-2010 年（时代 1，n=90）、2011-2016 年（时代 2，n=87）和 2017-2021 年（时代 3，n=81）。主要终点是评估随着时间的推移，适应证、手术策略和技术的变化以及经验的增加是否影响 A-AAD 修复的早期和晚期结果。腋动脉插管在时代 2（86%）和 3（91%）中几乎常规使用，而在时代 1 中主要使用单股股动脉插管（91%）（<0.01）。逆行性脑灌注在时代 1（60%）中主要使用，而顺行性脑灌注在时代 2（94%）和 3（100%）中首选；（<0.01）。弓部置换术的比例从时代 1（11%）显著增加到时代 2（33%）和 3（48%）（<0.01）。冷冻象鼻主要在时代 3 中进行。时代 1 的院内死亡率为 13%，时代 2 为 11%，时代 3 为 4%（=0.07）。3 年的累积生存率为 74%，时代 1 为 78%，时代 2 为 89%（=0.05）。随着经验的增加和更积极的方法，包括全弓置换术，许多患者可以在低手术死亡率的情况下进行 A-AAD 的修复。特定团队组织的患者护理和治疗可以更快地诊断和转介手术，从而进一步改善早期和晚期结果。
