Department for Cardiac Surgery, University Clinical Centre of Serbia, 11000 Belgrade, Serbia.
Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia.
Medicina (Kaunas). 2023 Dec 24;60(1):35. doi: 10.3390/medicina60010035.
: Despite advances in surgical techniques, industry adjuncts, and cerebral perfusion techniques, the in-hospital mortality rate of type A acute dissection (TAAD) remains at 15-30%. This study aimed to investigate the influence of different extents of aortic resection on survival and quality of life (QoL) after long-term follow-up. : A retrospective observational trial was performed, including 165 patients operated upon for TAAD. Patients were divided into two groups according to the extent of their aortic repair: the first group comprised patients who had ascending aorta replacement and the second included patients who had hemiarch or total arch replacement. The groups were compared with regard to their baseline characteristics, operative characteristics, survival, complications, and QoL during nine years of follow-up. : The mean follow-up time was 75.6 months (1-108 months). The mean survival in the ascending aorta repair group was 89.651 (81.242-98.061) months and was 54.801 (40.053-69.548) months in the hemiarch and arch group; the difference between the groups was significant (log-rank < 0.001). The rate of new postoperative neurological deficits was statistically higher in the hemiarch and arch group (17.5% vs. 8.4%, = 0.045), the most common being stroke, and was also more frequent in the hemiarch and arch group than in the ascending aorta group (with statistical significance (15.7% vs. 6.5%)). The mean SF-12 physical score from the QoL questionnaire was higher in the ascending aorta replacement group than in the hemiarch and arch group (50.1 ± 7.3 vs. 44.0 ± 11.9, = 0.017). Additionally, the mean SF-12 mental score was higher in the ascending aorta replacement group (52.3 ± 7.3 vs. 47.1 ± 12.8, = 0.032). : A more aggressive approach involving aortic arch repair means a lower survival rate and lesser quality of life after long-term follow-up in comparison with the replacement of the ascending aorta. If clinically applicable, a more defensive strategy may be considered.
尽管在外科技术、工业辅助和脑灌注技术方面取得了进展，但 A 型急性夹层（TAAD）的院内死亡率仍保持在 15-30%。本研究旨在探讨长期随访后不同程度的主动脉切除对生存和生活质量（QoL）的影响。
本研究进行了一项回顾性观察性试验，纳入了 165 例因 TAAD 而接受手术的患者。根据主动脉修复的范围，患者分为两组：第一组包括接受升主动脉置换术的患者，第二组包括接受半弓或全弓置换术的患者。比较两组患者的基线特征、手术特征、生存情况、并发症以及 9 年随访期间的 QoL。
平均随访时间为 75.6 个月（1-108 个月）。升主动脉修复组的平均生存时间为 89.651（81.242-98.061）个月，半弓和全弓组为 54.801（40.053-69.548）个月；两组间差异有统计学意义（对数秩检验<0.001）。半弓和全弓组新发术后神经功能缺损的发生率明显高于升主动脉修复组（17.5% vs. 8.4%，=0.045），最常见的是中风，且半弓和全弓组的发生率也明显高于升主动脉修复组（有统计学意义（15.7% vs. 6.5%））。生活质量问卷调查的 SF-12 生理评分均值在升主动脉置换组高于半弓和全弓组（50.1±7.3 vs. 44.0±11.9，=0.017）。此外，升主动脉置换组的 SF-12 心理评分均值也较高（52.3±7.3 vs. 47.1±12.8，=0.032）。
与升主动脉置换相比，主动脉弓修复的侵袭性方法意味着长期随访后的生存率降低，生活质量下降。如果在临床上可行，可能需要考虑更为保守的策略。
