Hattori Shigeru, Noguchi Kenichiro, Gunji Yusuke, Nagatsuka Motoki, Kagaya Hideo, Katayama Ikuo
Department of Cardiovascular Surgery, Shonan Kamakura General Hospital, 1370-1 Okamoto, Kamakura, Kanagawa, 247-8533, Japan.
Gen Thorac Cardiovasc Surg. 2023 Apr;71(4):225-231. doi: 10.1007/s11748-022-01864-w. Epub 2022 Aug 17.
The aim of this study is to evaluate our surgical strategy for acute aortic dissection Stanford A and determine whether it is safe regardless of the experience of the primary surgeon.
Between April 2015 and September 2020, a total of 160 patients who underwent open surgery for type A aortic dissection at Shonan Kamakura General Hospital were reviewed. Data were collected from reviews of computerized medical records. From this study cohort, we retrospectively reviewed the cases of trainee (group T) and experienced primary surgeons (group E). We evaluated rates of 30 day and in-hospital mortality, stroke, aortic reintervention, and mid-term survival for both groups.
The rates of 30 day and in-hospital mortalities in group T were 5.1 and 7.7%, respectively, whereas those in group E were 4.7 and 4.7%, respectively. One and 3 year survival rates in group T were 88.4 and 87.1% and in group E were 95.3 and 95.3%, respectively (log-rank test, p = 0.11). The 1 year and 3 year rates of freedom from reintervention were 90.9 and 72.8% in group T and 96.8 and 92.7% in group E, respectively (log-rank test, p = 0.29). The permanent neurological dysfunction rate was 8.1% overall, 8.5% in group T, and 7.0% in group E, with no significant difference.
Our surgical strategy for acute type A aortic dissection is safe and appropriate regardless of the experience of the primary surgeon.
本研究旨在评估我们针对斯坦福A型急性主动脉夹层的手术策略，并确定无论主刀医生的经验如何，该策略是否安全。
回顾了2015年4月至2020年9月间在湘南镰仓综合医院接受A型主动脉夹层开放手术的160例患者。数据通过查阅电子病历收集。从该研究队列中，我们回顾性分析了实习医生组（T组）和经验丰富的主刀医生组（E组）的病例。我们评估了两组的30天和住院死亡率、中风、主动脉再次干预以及中期生存率。
T组的30天和住院死亡率分别为5.1%和7.7%，而E组分别为4.7%和4.7%。T组的1年和3年生存率分别为88.4%和87.1%，E组分别为95.3%和95.3%（对数秩检验，p = 0.11）。T组的1年和3年无再次干预率分别为90.9%和72.8%，E组分别为96.8%和92.7%（对数秩检验，p = 0.29）。永久性神经功能障碍率总体为8.1%，T组为8.5%，E组为7.0%，无显著差异。
无论主刀医生的经验如何，我们针对急性A型主动脉夹层的手术策略都是安全且合适的。
