开放修复术与胸降主动脉瘤腔内修复术的中期结果
Midterm outcomes of open repair versus endovascular descending thoracic aortic aneurysm repair.
作者信息
Orelaru Felix, Monaghan Katelyn, Ahmad Rana-Armaghan, Amin Kush, Titsworth Marc, Yang Jie, Kim Karen M, Fukuhara Shinichi, Patel Himanshu, Yang Bo
机构信息
Department of General Surgery, Trinity Health Ann Arbor Hospital, Ann Arbor, Mich.
Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
出版信息
JTCVS Open. 2023 Oct 1;16:25-35. doi: 10.1016/j.xjon.2023.09.034. eCollection 2023 Dec.
OBJECTIVE
The study objective was to evaluate the midterm outcome of thoracic endovascular aortic repair compared with open repair in patients with descending thoracic aortic aneurysm.
METHODS
From August 1993 to February 2023, 499 patients with descending thoracic aortic aneurysms underwent open repair (n = 221) or thoracic endovascular aortic repair (n = 278). Of these, 120 matched pairs were identified using propensity score matching based on age, sex, chronic lung disease, stroke, coronary artery disease, diabetes, ejection fraction, dialysis, peripheral vascular disease, prior cardiac surgery, connective tissue disease, and chronic dissection. Primary outcomes were postoperative paralysis, operative mortality, reoperation, and midterm survival.
RESULTS
After matching, the preoperative demographics and comorbidities were balanced in both groups. Intraoperatively, open repair had a lower temperature (18 °C vs 36 °C) and more patients required blood products (66% vs 8%), < .001. Postoperatively, patients undergoing thoracic endovascular aortic repair had fewer strokes (2.5% vs 9.2%; = .03), less dialysis (0% vs 3.3%; = .04), and shorter length of stay (5 days vs 12 days, < .001), but similar lower-extremity paralysis (2.5% vs 2.5%, = 1.00) compared with open repair. Furthermore, thoracic endovascular aortic repair had higher 7-year incidence of first reoperation (16.1% vs 3.6%, < .001) but similar operative mortality (0.8% vs 4.2%; = .10) and 10-year survival outcome (56%; 95% CI, 43-72 vs 58%; 95% CI, 49-68; = .55) compared with open aortic repair. The hazard ratio was 0.93 ( = .78) for thoracic endovascular aortic repair for midterm mortality and 6.87 ( < .001) for reoperation.
CONCLUSIONS
Open repair could be the first option for patients with descending thoracic aortic aneurysms who were surgical candidates.
目的
本研究旨在评估降主动脉瘤患者行胸主动脉腔内修复术与开放修复术的中期疗效。
方法
1993年8月至2023年2月，499例降主动脉瘤患者接受了开放修复术（n = 221）或胸主动脉腔内修复术（n = 278）。其中，基于年龄、性别、慢性肺病、中风、冠状动脉疾病、糖尿病、射血分数、透析、外周血管疾病、既往心脏手术、结缔组织病和慢性夹层，采用倾向评分匹配法确定了120对匹配病例。主要结局指标为术后瘫痪、手术死亡率、再次手术和中期生存率。
结果
匹配后，两组患者术前人口统计学特征和合并症情况均衡。术中，开放修复术体温较低（18℃对36℃），更多患者需要输血制品（66%对8%），P < 0.001。术后，与开放修复术相比，接受胸主动脉腔内修复术的患者中风较少（2.5%对9.2%；P = 0.03），透析需求较少（0%对3.3%；P = 0.04），住院时间较短（5天对12天，P < 0.001），但下肢瘫痪发生率相似（2.5%对2.5%，P = 1.00）。此外，与开放主动脉修复术相比，胸主动脉腔内修复术首次再次手术的7年发生率较高（16.1%对3.6%，P < 0.001），但手术死亡率相似（0.8%对4.2%；P = 0.10），10年生存结局相似（56%；95%CI，43 - 72对58%；95%CI，49 - 68；P = 0.55）。胸主动脉腔内修复术中期死亡率的风险比为0.93（P = 0.78），再次手术的风险比为6.87（P < 0.001）。
结论
对于适合手术的降主动脉瘤患者，开放修复术可能是首选方案。
Zotero 插件