Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas; Office of Surgical Research, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas.
Ann Thorac Surg. 2024 Feb;117(2):328-335. doi: 10.1016/j.athoracsur.2023.10.012. Epub 2023 Oct 21.
Crawford extent I thoracoabdominal aortic aneurysm (TAAA) repairs are increasingly performed by an endovascular approach, including in patients with heritable thoracic aortic disease (HTAD). We evaluated outcomes after open extent I TAAA repair in patients with and without HTAD.
This retrospective study included 992 patients (median age, 67 years; quartile 1-quartile 3, 57-73 years) who underwent extent I TAAA (1990-2022), stratified by the presence of HTAD (n = 177 [17.8%]). Patients with HTAD had genetic aortopathies or presented at age ≤50 years, and 35% (62 of 177) had Marfan syndrome. Logistic regression was used to identify predictors of operative death and adverse event, a composite of operative death and persistent (present at discharge) stroke, paraplegia, paraparesis, and renal failure necessitating dialysis. Long-term outcomes were analyzed with competing risks analysis.
Patients with HTAD had lower rates of operative mortality (1.7% vs 7.0%, P = .01) and composite adverse event (2.8% vs 12.3%, P < .001) than non-HTAD patients. Most HTAD patients were discharged home (92.6% vs 76.9%, P < .001). Predictors of operative death were increasing age, aortic dissection, tobacco use, chronic symptoms, and rupture. Predictors for adverse event were increasing age, acute symptoms, chronic dissection, and rupture. Patients with HTAD had substantially better repair-failure-free survival (P < .001).
Open extent I TAAA repair was effective in patients with HTAD, with low operative mortality and adverse event rates, better late survival, and excellent long-term durability, making a compelling argument for preferring open repair in these patients.
Crawford Ⅰ型胸腹主动脉瘤（TAAA）的血管内修复术越来越多地被采用，包括遗传性胸主动脉疾病（HTAD）患者。我们评估了 HTAD 患者与非 HTAD 患者行开放Ⅰ型 TAAA 修复术的结局。
本回顾性研究纳入了 992 例（中位年龄 67 岁；四分位间距 1-3 分位间距 57-73 岁）行Ⅰ型 TAAA 术（1990-2022 年）的患者，根据是否存在 HTAD 进行分层（n=177[17.8%]）。HTAD 患者存在遗传性主动脉疾病或 50 岁前发病，35%（62/177）为马凡综合征。采用 logistic 回归分析确定手术死亡和不良事件（手术死亡和持续性[出院时存在]脑卒中、截瘫、轻截瘫和需要透析的肾衰竭的复合终点）的预测因素。采用竞争风险分析评估长期结局。
与非 HTAD 患者相比，HTAD 患者的手术死亡率（1.7% vs. 7.0%，P=0.01）和复合不良事件发生率（2.8% vs. 12.3%，P<0.001）较低。大多数 HTAD 患者出院回家（92.6% vs. 76.9%，P<0.001）。手术死亡的预测因素包括年龄增长、主动脉夹层、吸烟、慢性症状和破裂。不良事件的预测因素包括年龄增长、急性症状、慢性夹层和破裂。HTAD 患者的修复失败无事件生存率显著提高（P<0.001）。
开放Ⅰ型 TAAA 修复术对 HTAD 患者有效，手术死亡率和不良事件发生率较低，晚期生存率更好，长期耐用性良好，强烈支持对这些患者首选开放修复。
