Wang Long-Fei, Li Yu, Jin Mu, Li Hai-Bin, Zhang Nan, Gong Ming, Zhang Hong-Jia, Liu Yu-Yong, Lai Yong-Qiang
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Department of Radiology, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen, China.
Front Surg. 2024 Apr 9;11:1329771. doi: 10.3389/fsurg.2024.1329771. eCollection 2024.
The diameter, area, and volume of the true lumen and false lumen (FL) have been measured in previous studies to evaluate the extent of DeBakey type I aortic dissection. However, these indicators have limitations because of the irregular shapes of the true and false lumens and the constant oscillation of intimal flap during systole and diastole. The ratio of arch lengths seems to be a more reliable indicator. FL% was defined as the ratio of the arch length of FL to the circumference of the aorta at the different levels of the aorta. The purpose of this article was to investigate whether FL% is a predictor of the severity of acute DeBakey type I aortic dissection in patients undergoing frozen elephant trunk (FET) and total arch replacement.
In this retrospective observational study, we analyzed a total of 344 patients with acute DeBakey type I aortic dissection that underwent FET and total arch replacement at our center from October 2015 to October 2019. The patients were divided into two groups by cluster analysis according to the perioperative course. Binary logistic regression analyses were performed to determine whether FL% could predict the severity of acute DeBakey type I aortic dissection. The area under the receiver operating characteristic curve (AUROC) was used to assess the power of the multivariate logistic regression model for the severity of acute DeBakey type I aortic dissection.
The patients in the ultra-high-risk group (109 patients) had significantly more severe clinical comorbidities and complications than the patients in the high-risk group (235 patients). The ascending aortic FL% [odds ratio (OR), 11.929 (95% CI: 1.421-100.11); = 0.022], location of initial tear [OR, 0.68 (95% CI: 0.47-0.98); = 0.041], the degree of left iliac artery involvement [OR, 1.95 (95% CI: 1.15-3.30); = 0.013], and the degree of right coronary artery involvement [OR, 1.46 (95% CI: 1.01-2.12); = 0.045] on preoperative computed tomography angiography were associated with the severity of acute DeBakey type I aortic dissection. The AUROC value of this multivariate logistic regression analysis was 0.940 (95% CI: 0.914-0.967; < 0.001). The AUROC value of ascending aortic FL% was 0.841 (95% CI: 0.798-0.884; < 0.001) for the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement.
Ascending aortic FL% was validated as an essential radiologic index for assessing the severity of acute DeBakey type I aortic dissection in patients undergoing FET and total arch replacement. Higher values of ascending aortic FL% were more severe.
在既往研究中已对真腔和假腔（FL）的直径、面积及体积进行测量，以评估DeBakey I型主动脉夹层的累及范围。然而，由于真腔和假腔形状不规则，且内膜瓣在收缩期和舒张期持续摆动，这些指标存在局限性。弓部长度比似乎是一个更可靠的指标。FL%定义为在主动脉不同水平处，FL的弓部长度与主动脉周长的比值。本文旨在探讨FL%是否可作为接受象鼻支架植入术（FET）和全弓置换术的急性DeBakey I型主动脉夹层患者病情严重程度的预测指标。
在这项回顾性观察研究中，我们分析了2015年10月至2019年10月在本中心接受FET和全弓置换术的344例急性DeBakey I型主动脉夹层患者。根据围手术期过程，通过聚类分析将患者分为两组。进行二元逻辑回归分析以确定FL%是否可预测急性DeBakey I型主动脉夹层的严重程度。采用受试者工作特征曲线下面积（AUROC）评估多因素逻辑回归模型对急性DeBakey I型主动脉夹层严重程度的预测能力。
超高危组（109例患者）的临床合并症和并发症比高危组（235例患者）严重得多。术前计算机断层扫描血管造影显示，升主动脉FL%[比值比（OR），11.929（95%CI：1.421 - 100.11）；P = 0.022]、初始撕裂部位[OR，0.68（95%CI：0.47 - 0.98）；P = 0.041]、左髂动脉受累程度[OR，1.95（95%CI：1.15 - 3.30）；P = 0.013]以及右冠状动脉受累程度[OR，1.46（95 %CI：1.01 - 2.12）；P = 0.045]与急性DeBakey I型主动脉夹层的严重程度相关。该多因素逻辑回归分析的AUROC值为0.940（95%CI：0.914 - 0.967；P < 0.001）。对于接受FET和全弓置换术的急性DeBakey I型主动脉夹层患者，升主动脉FL%的AUROC值为0.841（95%CI：0.798 - 0.884；P < 0.001）。
升主动脉FL%被证实是评估接受FET和全弓置换术的急性DeBakey I型主动脉夹层患者严重程度的重要影像学指标。升主动脉FL%值越高，病情越严重。
