Kawasaki Aortic Center, Kawasaki Saiwai Hospital, Kawasaki, Japan.
Department of Biostatistics, Medical Center for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
Interact Cardiovasc Thorac Surg. 2022 Sep 9;35(4). doi: 10.1093/icvts/ivac233.
Thoracic endovascular aortic repair is a widely accepted treatment for chronic aortic dissection because of good early results compared to open surgical repair. We provide early and long-term results of descending thoracic aortic repair for chronic aortic dissection.
Patients who underwent descending thoracic aortic repair for chronic aortic dissection between January 2012 and December 2020 at Kawasaki Aortic Centre were included in this analysis.
Four hundred ninety-two patients (median age, 64 years; interquartile range, 52-75 years) were included. The median duration of follow-up was 3.2 years (interquartile range, 1.5-5.2 years). The early mortality rate was 2.0% (n = 10); strokes occurred in 17 patients (3.5%); and spinal cord injuries occurred in 30 patients (6.1%). Early major adverse events including early death, stroke, spinal cord injury, tracheostomy and haemodialysis at the time of discharge occurred in 62 patients. Multivariable analysis indicated that age > 70 years and non-elective surgery were predictors of early major adverse events. Among patients without both risk factors (i.e. low-risk patients), 1 early death (0.4%), 3 strokes (1.5%) and 1 spinal cord injury (0.4%) were observed, 2 tracheostomies were performed (0.8%) and no patients required haemodialysis at the time of hospital discharge. The 5-year survival rate was 87.2%. The cumulative incidence of chronic aortic dissection-related aortic reintervention at 5 years was 7.9%.
Descending thoracic aortic repair for chronic aortic dissection resulted in good early and long-term results, and it can serve as the gold standard for low-risk patients.
与开放手术修复相比，胸主动脉腔内修复术治疗慢性主动脉夹层具有良好的早期效果，因此被广泛应用。本研究旨在提供慢性主动脉夹层胸主动脉修复的早期和长期结果。
本研究纳入了 2012 年 1 月至 2020 年 12 月期间在川崎主动脉中心接受慢性主动脉夹层胸主动脉修复的患者。
本研究共纳入 492 例患者（中位年龄为 64 岁，四分位间距为 52-75 岁）。中位随访时间为 3.2 年（四分位间距为 1.5-5.2 年）。早期死亡率为 2.0%（n=10）；17 例患者发生脑卒中（3.5%）；30 例患者发生脊髓损伤（6.1%）。早期主要不良事件（包括早期死亡、脑卒中、脊髓损伤、气管切开术和出院时血液透析）发生于 62 例患者。多变量分析表明，年龄>70 岁和非择期手术是早期主要不良事件的预测因素。在无这两个危险因素的患者中（即低危患者），观察到 1 例早期死亡（0.4%）、3 例脑卒中（1.5%）和 1 例脊髓损伤（0.4%），实施了 2 例气管切开术（0.8%），出院时无患者需要血液透析。5 年生存率为 87.2%。5 年慢性主动脉夹层相关主动脉再介入的累积发生率为 7.9%。
慢性主动脉夹层胸主动脉修复的早期和长期效果良好，可作为低危患者的金标准。
