Ram Eilon, Lau Christopher, Dimagli Arnaldo, Chu Ngoc-Quynh, Soletti Giovanni, Gaudino Mario, Girardi Leonard N
Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY.
Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
JTCVS Tech. 2023 May 24;20:10-19. doi: 10.1016/j.xjtc.2023.05.003. eCollection 2023 Aug.
The 2 most acceptable techniques for reimplantation of the supra-aortic vessels in total arch replacement include the branched graft technique (debranching) or en bloc technique (island). We aim to review our experience with total arch replacement and report short- and long-term outcomes from a high-volume center dedicated to surgery for the thoracic aorta.
The aortic surgery database was queried to identify all consecutive patients undergoing total arch replacement between 1997 and 2022. Of the 426 patients who underwent total arch replacement, 303 (71%) received the island technique and 123 (29%) received the debranching approach. Operative and long-term outcomes were compared using multivariable models.
The debranching group was younger (64 ± 14 years vs 69 ± 12 years, = .001), had undergone more previous cardiac operations (54.5% vs 27.4%, < .001), and had more connective tissue disorder (20.3% vs 4.6%, < .001). The debranching approach was associated with longer total circulatory arrest time (47 ± 15 minutes vs 37 ± 10 minutes, < .001) and cardiac ischemic time (116 ± 41 minutes vs 100 ± 37 minutes, < .001). More patients in the debranching group received blood products intraoperatively or postoperatively (56.1% vs 42.9%, = .018). All other early outcomes did not differ between groups. Overall operative mortality was 1.4% (2.4% vs 1%, = .486); the incidence of major postoperative complications was 6.3% (5.7% vs 6.6%, = .897). Ten-year survival was 80% (78% vs 80.9%, log-rank = .356). Multivariable Cox regression analysis demonstrated that neither surgical approach was associated with survival advantage (hazard ratio, 1.18; 0.73-1.89; = .495).
Debranching requires a longer operative time, with similar early and long-term outcomes. Preoperative comorbidity, not surgical technique, predicts major adverse events and long-term survival.
在全弓置换术中，用于主动脉弓上血管再植入的两种最可接受的技术包括分支移植物技术（去分支）或整块技术（岛状技术）。我们旨在回顾我们在全弓置换方面的经验，并报告一个专注于胸主动脉手术的高容量中心的短期和长期结果。
查询主动脉手术数据库，以识别1997年至2022年间所有连续接受全弓置换的患者。在426例接受全弓置换的患者中，303例（71%）采用岛状技术，123例（29%）采用去分支方法。使用多变量模型比较手术和长期结果。
去分支组患者更年轻（64±14岁 vs 69±12岁，P = 0.001），既往接受心脏手术的次数更多（54.5% vs 27.4%，P < 0.001），结缔组织疾病更多（20.3% vs 4.6%，P < 0.001）。去分支方法与总循环阻断时间更长（47±15分钟 vs 37±10分钟，P < 0.001）和心脏缺血时间更长（116±41分钟 vs 100±37分钟，P < 0.001）相关。去分支组更多患者在术中或术后接受血液制品（56.1% vs 42.9%，P = 0.018）。两组之间所有其他早期结果无差异。总体手术死亡率为1.4%（2.4% vs 1%，P = 0.486）；术后主要并发症发生率为6.3%（5.7% vs 6.6%，P = 0.897）。十年生存率为80%（78% vs 80.9%，对数秩检验P = 0.356）。多变量Cox回归分析表明，两种手术方法均未显示出生存优势（风险比，1.18；0.73 - 1.89；P = 0.495）。
去分支技术需要更长的手术时间，但早期和长期结果相似。术前合并症而非手术技术可预测主要不良事件和长期生存。
