Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA -
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
J Cardiovasc Surg (Torino). 2022 Jun;63(3):275-280. doi: 10.23736/S0021-9509.22.12290-1. Epub 2022 Mar 3.
Aortic arch repair has undergone constant evolution since its inception with improving outcomes. A sizeable number of competing techniques and strategies have been described, with no single optimal method endorsed by the surgical community. We describe our experience with open aortic arch repair in a high-volume center.
We queried our aortic database for consecutive patients undergoing aortic arch repair from 1997-2021. Those undergoing hemiarch repair were compared to those undergoing total arch repair. Outcomes were compared using multivariate analysis.
Of 1308 patients undergoing aortic arch repair, 953 underwent hemiarch repair and 355 underwent total arch repair. The median age was 69 (interquartile ratio 58-76) and 61.7% were men. Hemiarch patients more frequently hade aortic dissection (28.5 vs. 11.8%, P<0.001) and urgent or emergent procedure status (45.1 vs. 30.4%, P<0.001). Overall operative mortality was 2.7% and significantly higher in the hemiarch group (3.5 vs. 0.6%, P=0.007). No difference in the incidence of major adverse events (MAE) including myocardial infarction, cerebrovascular accident, new need for dialysis, re-exploration for bleeding, and tracheostomy was found between the two groups. Multivariate analysis found diabetes, urgent or emergent procedure status, preoperative renal dysfunction, New York Heart Association class III/IV symptoms, and connective tissue disease to be independent predictors of MAE.
Retrograde cerebral perfusion with deep hypothermic circulatory arrest is safe and effective, with no appreciable difference in neurologic outcomes when comparing hemiarch to total arch strategies. Rates of mortality and MAE compare favorably with strategies utilizing antegrade cerebral perfusion.
自主动脉弓修复术问世以来，其一直在不断发展，以改善治疗效果。目前已经提出了大量相互竞争的技术和策略，但没有一种单一的最佳方法得到外科界的认可。我们描述了我们在一个高容量中心进行开放式主动脉弓修复的经验。
我们在主动脉数据库中查询了 1997 年至 2021 年间连续接受主动脉弓修复的患者。将行半弓修复的患者与行全弓修复的患者进行比较。使用多变量分析比较结果。
在 1308 例接受主动脉弓修复的患者中，953 例行半弓修复，355 例行全弓修复。中位年龄为 69 岁（四分位间距 58-76 岁），61.7%为男性。半弓患者更常患有主动脉夹层（28.5%比 11.8%，P<0.001）和紧急或急诊手术状态（45.1%比 30.4%，P<0.001）。总的手术死亡率为 2.7%，半弓组显著更高（3.5%比 0.6%，P=0.007）。两组之间主要不良事件（MAE）包括心肌梗死、脑血管意外、新需要透析、因出血再次探查、气管切开的发生率无差异。多变量分析发现糖尿病、紧急或急诊手术状态、术前肾功能不全、纽约心脏协会 III/IV 级症状和结缔组织疾病是 MAE 的独立预测因素。
逆行性脑灌注加深低温停循环是安全有效的，与全弓策略相比，在神经功能结果方面没有明显差异。死亡率和 MAE 的发生率与使用顺行性脑灌注的策略相比具有优势。
