Kim Do Jung, Song Joon-Young, Shin Han-Bit, Lee Seung Hyun, Lee Sak, Youn Young-Nam, Yoo Kyung-Jong, Joo Hyun-Chel
Department of Thoracic and Cardiovascular Surgery, Ajou University Hospital, Ajou University School of Medicine, Suwon, Korea; Department of Thoracic and Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Thoracic and Cardiovascular Surgery, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju, Korea.
Ann Thorac Surg. 2023 Apr;115(4):896-903. doi: 10.1016/j.athoracsur.2022.09.023. Epub 2022 Sep 24.
This study evaluated the effect of residual arch tears on late reinterventions and arch dilatation after hemiarch replacement for patients with acute DeBakey type I aortic dissection.
Between January 1995 and October 2018, 160 consecutive patients who underwent hemiarch replacement for DeBakey type I dissection were retrospectively enrolled. They were divided into patients with (n = 73) and without (n = 87) residual arch tears. The arch tears group was subdivided into the proximal/middle arch (n = 26) and distal arch (n = 47) groups to evaluate arch growth rates according to the locations of residual arch tears. The endpoints were arch growth rate and late arch and composite events.
The arch diameter increased significantly over time in patients with residual arch tears (1.620 mm/y, P < .001). The increase occurred more rapidly when residual tears occurred at the distal arch than at the proximal/middle arch level (2.101 vs 1.001 mm/y). In the adjusted linear mixed model, residual arch tears or luminal communications at the distal arch level were significant factors associated with increases in the arch diameter over time. The 10-year freedom from late arch and composite event rate was significantly lower for patients with residual arch tears than for those without (82.4% vs 95.5%, P = .001; and 68.0% vs 89.3%, P = .002, respectively).
Residual arch tears are significant factors associated with late arch dilatation and reinterventions, especially for patients with distal arch tears. Extensive arch replacement during the initial surgery to avoid residual arch tears may improve long-term outcomes.
本研究评估了急性DeBakey I型主动脉夹层患者半弓置换术后残余主动脉弓撕裂对晚期再次干预及主动脉弓扩张的影响。
回顾性纳入1995年1月至2018年10月期间连续160例行DeBakey I型夹层半弓置换术的患者。将其分为有残余主动脉弓撕裂（n = 73）和无残余主动脉弓撕裂（n = 87）的患者。主动脉弓撕裂组再细分为近端/中段主动脉弓（n = 26）和远端主动脉弓（n = 47）组，以根据残余主动脉弓撕裂的位置评估主动脉弓生长速率。终点指标为主动脉弓生长速率、晚期主动脉弓及复合事件。
有残余主动脉弓撕裂的患者主动脉弓直径随时间显著增加（1.620 mm/年，P <.001）。当残余撕裂发生在远端主动脉弓时，其增加速度比发生在近端/中段主动脉弓水平时更快（2.101 vs 1.001 mm/年）。在调整后的线性混合模型中，远端主动脉弓水平的残余主动脉弓撕裂或管腔连通是与主动脉弓直径随时间增加相关的显著因素。有残余主动脉弓撕裂的患者10年无晚期主动脉弓及复合事件发生率显著低于无残余主动脉弓撕裂的患者（分别为82.4% vs 95.5%，P =.001；以及68.0% vs 89.3%，P =.002）。
残余主动脉弓撕裂是与晚期主动脉弓扩张和再次干预相关的重要因素，尤其是对于有远端主动脉弓撕裂的患者。在初次手术期间进行广泛的主动脉弓置换以避免残余主动脉弓撕裂可能会改善长期预后。
