Department of Cardiovascular Surgery, University Heart Center Freiburg, Faculty of Medicine, Albert-Ludwigs-University of Freiburg, Freiburg, Germany.
Interact Cardiovasc Thorac Surg. 2022 Jun 15;35(1). doi: 10.1093/icvts/ivac042.
The aim of this study was to analyse outcomes of thoracic endovascular aortic repair to treat aortic rupture.
Patient and outcome characteristics of all emergent endovascular treatments for thoracic aortic rupture between January 2009 and December 2019 were analysed.
Thoracic aortic rupture occurred in patients with aortic aneurysms (n = 42, 49%), aortic dissection (n = 13, 16%) or after trauma (n = 30, 35%). Preoperative cerebrospinal fluid drainage was placed in 9 patients (11%) and 18 patients (21%) underwent perioperative supra-aortic transposition. The proximal landing zones were: zone 1 (n = 1, 1%), zone 2 (n = 23, 27%), zone 3 (n = 52, 61%) and zone 4 (n = 9, 11%). Temporary spinal cord injury occurred in 1 patient (1%), permanent spinal cord injury in 7 patients (8%). Two patients (2%) experienced a postoperative stroke. Seventeen patients (20%) expired in-hospital. Aortic dissection (odds ratio: 16.246, p = 0.001), aneurysm (odds ratio: 9.090, P = 0.003) and preoperative shock (odds ratio: 4.646, P < 0.001) were predictive for mortality. Eighteen patients (21%) required a stent-graft-related aortic reintervention for symptomatic supra-aortic malperfusion (n = 3, 4%), endoleaks (n = 6, 7%), a second aortic rupture (n = 4, 5%), retrograde type A aortic dissection (n = 2, 2%), aortic-oesophageal fistulation (n = 2, 2%) and stent-graft kinking (n = 1, 1%).
Thoracic endovascular aortic repair in patients with aortic rupture has become a valuable treatment modality to stabilize patients. However, a significant risk of postoperative morbidity and mortality remains, particularly in patients with aortic dissections, aneurysms or shock. Patients require thorough follow-up ideally in an aortic clinic with a staff having the entire spectrum of cardiovascular and thoracic surgical expertise.
本研究旨在分析胸主动脉腔内修复术治疗主动脉破裂的结果。
分析 2009 年 1 月至 2019 年 12 月期间所有紧急血管内治疗胸主动脉破裂的患者和结局特征。
主动脉破裂发生在主动脉瘤患者（n=42，49%）、主动脉夹层患者（n=13，16%）或外伤后患者（n=30，35%）。9 例（11%）患者术前行脑脊液引流，18 例（21%）患者行术中主动脉弓上转位。近端着陆区为：1 区（n=1，1%）、2 区（n=23，27%）、3 区（n=52，61%）和 4 区（n=9，11%）。1 例（1%）患者发生暂时性脊髓损伤，7 例（8%）患者发生永久性脊髓损伤。2 例（2%）患者发生术后卒中。17 例（20%）患者院内死亡。主动脉夹层（优势比：16.246，p=0.001）、动脉瘤（优势比：9.090，P=0.003）和术前休克（优势比：4.646，P<0.001）是死亡的预测因素。18 例（21%）患者因症状性主动脉弓上灌注不良（n=3，4%）、内漏（n=6，7%）、第二次主动脉破裂（n=4，5%）、逆行型 A 型主动脉夹层（n=2，2%）、主动脉-食管瘘（n=2，2%）和支架移植物扭结（n=1，1%）需要再次进行支架-移植物相关的主动脉干预。
胸主动脉腔内修复术治疗主动脉破裂已成为稳定患者的一种有价值的治疗方法。然而，术后发病率和死亡率仍然很高，特别是在主动脉夹层、动脉瘤或休克患者中。患者需要在主动脉科进行彻底的随访，理想情况下，该科室的工作人员应具备心血管和胸外科的全部专业知识。
