Jormalainen Mikko, Kesävuori Risto, Raivio Peter, Vento Antti, Mustonen Caius, Honkanen Hannu-Pekka, Rosato Stefano, Simpanen Jarmo, Teittinen Kari, Biancari Fausto, Juvonen Tatu
Division of Cardiac Surgery, Heart and Lung Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Department of Radiology, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
Interact Cardiovasc Thorac Surg. 2022 Feb 21;34(3):453-461. doi: 10.1093/icvts/ivab324.
We investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD).
Patients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan-Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method.
Out of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77-2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15-1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm2/year and that of its perimeter 0.43 mm/year.
When stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes.
我们研究了选择性使用冠状动脉上方升主动脉置换术是否能获得与急性 Stanford A 型主动脉夹层（TAAD）主动脉根部置换术相当的远期疗效。
纳入 2005 年至 2018 年在芬兰赫尔辛基大学医院接受急性 A 型主动脉夹层手术的患者进行分析。采用 Kaplan-Meier 法评估远期死亡率，采用竞争风险法评估主动脉近端再次手术，即主动脉根部或主动脉瓣手术。
309 例患者中，216 例行冠状动脉上方升主动脉置换术，93 例行主动脉根部置换术。10 年时，主动脉根部置换术后死亡率为 33.8%，升主动脉置换术后死亡率为 35.2%（P = 0.806，调整后风险比 1.25，95%置信区间，0.77 - 2.02），主动脉根部置换组主动脉近端再次手术的累积发生率为 6.0%，升主动脉置换组为 6.2%（P = 0.65；调整后亚分布风险比 0.53，95%置信区间 0.15 - 1.89）。在 71 对倾向评分匹配的病例中，主动脉根部置换术后 10 年生存率为 34.4%，升主动脉置换术后为 36.2%（P = 0.70）。主动脉根部置换术后主动脉近端再次手术的累积发生率为 7.0%，升主动脉置换术后为 13.0%（P = 0.22）。在 102 例有完整影像数据的患者中[平均随访时间，4.7（3.2）年]，主动脉根部直径的估计增长率为 0.22 mm/年，面积为 7.19 mm²/年，周长为 0.43 mm/年。
当采用严格的选择标准来确定主动脉近端重建范围时，A型主动脉夹层的主动脉根部置换术和升主动脉置换术可获得相当的临床疗效。
