Sirota D A, Zhulkov M O, Khvan D S, Caus T, Kozlov B N, Protopopov A V, Makayev A G, Fomichev A V, Agayeva Kh A, Sabetov A K, Lukinov V L, Edemsky A G, Chernyavsky A M
Head of the Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Aorta and Coronary Artery Surgery; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia.
Researcher, Research Department of Surgery on Aorta, Coronary and Peripheral Arteries, Institute of Blood Circulation Pathology; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia; Cardiovascular Surgeon, Department of Aorta and Coronary Artery Surgery; Meshalkin National Medical Research Center of the Ministry of Health of the Russian Federation, 15 Rechkunovskaya St., Novosibirsk, 630055, Russia.
Sovrem Tekhnologii Med. 2023;15(3):42-51. doi: 10.17691/stm2023.15.3.05. Epub 2023 May 28.
is to evaluate the efficacy of various types of hybrid technology in compare to the classical repair of the aortic arch of type I aortic dissection treatment in the in-hospital period.
A retrospective observational study has been conducted, the results of surgical treatment of 213 patients with DeBakey type I aortic dissection operated on within the period from 2001 to 2017 were compared. Patients were divided into three groups: in group 1, patients undergone a hemiarch type of aortic repair or the total arch replacement (n=121); in group 2, a hemiarch aortic reconstruction and implantation of bare metal stent was performed (n=55); in group 3, a frozen elephant trunk technique was used (n=37). Taking into consideration the retrospective character of the investigation and nonequivalence of the groups by separate characteristics, they were equalized to improve the reliability of the results using the PSM (propensity score matching) pseudorandomization method. As a result, three groups of comparison were formed which were equalized by the PSM method and called PSM 1, 2, and 3. The mortality and complication rate in the in-hospital period, as well as the frequency of false lumen thrombosis development depending on the treatment method, have been analyzed.
The mortality rate in the PSM 1 group was 15 patients: group 1 (standard technique) - 10 patients (9%), group 2 (uncoated stents) - 5 patients (11%). A significant difference was found in the number of major bleedings (group 1 - 8%, group 2 - 21%, p=0.031) and cases of bowel ischemia (group 1 - 1%, group 2 - 9%, p=0.028). Complete false lumen thrombosis of the thoracic aorta was observed significantly more often in group 1 than in group 2 (22% vs 5%, p=0.015).In the examined group PSM 2, hospital mortality rate was 4 patients: group 1 - 3 patients (12%), group 3 - 1 patient (3%). No differences between the groups were found in the number of complications. In group 3, complete false lumen thrombosis of the thoracic aorta was observed in 59% of cases, whereas in group 1 it was found only in 4% of patients (p<0.001).In comparison group PSM 3, the mortality was 8 patients: group 2 - 5 patients (11%), group 3 - 3 patients (9%). The number of neurological complications differed significantly: in group 2 - 27%, in group 3 - 6% (p=0.019). Besides, 3% of cases of complete false lumen thrombosis were found in group 2, while there appeared 55% (p<0.001) of such patients in group 3.
The comparative analysis showed that the use of bare metal stents and hybrid prostheses demonstrated a comparable low level of in-hospital mortality compared to the standard surgical technique of aortic arch reconstruction. At the same time, the use of the bare metal stents is associated with a higher rate of perioperative complications (bleeding, postoperative bowel ischemia, neurological complications) compared to the standard treatment and repair of the aortic dissection using hybrid prostheses. Complete thrombosis of the false lumen occurred significantly less commonly in case of using bare metal stents than with standard treatment and hybrid prostheses.
目的是评估与经典的I型主动脉夹层主动脉弓修复术相比，各种杂交技术在住院期间治疗I型主动脉夹层的疗效。
进行了一项回顾性观察研究，比较了2001年至2017年期间接受手术治疗的213例DeBakey I型主动脉夹层患者的手术结果。患者分为三组：第1组，接受半弓型主动脉修复或全弓置换的患者（n = 121）；第2组，进行半弓主动脉重建并植入裸金属支架（n = 55）；第3组，采用冰冻象鼻技术（n = 37）。考虑到研究的回顾性特点以及各组在个体特征上的不均衡性，采用倾向评分匹配（PSM）伪随机化方法对各组进行均衡处理，以提高结果的可靠性。结果，形成了三组通过PSM方法均衡后的比较组，分别称为PSM 1、PSM 2和PSM 3。分析了住院期间的死亡率、并发症发生率以及根据治疗方法不同的假腔血栓形成频率。
PSM 1组的死亡率为15例患者：第1组（标准技术） - 10例患者（9%），第2组（裸金属支架） - 5例患者（11%）。在严重出血数量（第1组 - 8%，第2组 - 21%，p = 0.031）和肠缺血病例（第1组 - 1%，第2组 - 9%，p = 0.028）方面发现了显著差异。第1组胸主动脉完全假腔血栓形成的观察频率明显高于第2组（22%对5%，p = 0.015）。在PSM 2检查组中，医院死亡率为4例患者：第1组 - 3例患者（12%），第3组 - 1例患者（3%）。各组在并发症数量上未发现差异。在第3组中，59%的病例观察到胸主动脉完全假腔血栓形成，而在第1组中仅在4%的患者中发现（p < 0.001）。在比较组PSM 3中，死亡率为8例患者：第2组 - 5例患者（11%），第3组 - 3例患者（9%）。神经并发症数量有显著差异：第2组 - 27%，第3组 - 6%（p = 0.019）。此外，第2组中发现3%的完全假腔血栓形成病例，而第3组中出现此类患者的比例为55%（p < 0.001）。
对比分析表明，与主动脉弓重建的标准手术技术相比，使用裸金属支架和杂交假体在住院死亡率方面表现出相当低的水平。同时，与标准治疗和使用杂交假体修复主动脉夹层相比，使用裸金属支架与围手术期并发症（出血、术后肠缺血、神经并发症）发生率较高相关。使用裸金属支架时假腔完全血栓形成的情况明显少于标准治疗和杂交假体。
