Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China.
Department of Cardiovascular Surgery, Fujian Medical University Union Hospital, Fuzhou, Fujian, PR China; Key Laboratory of Cardio-Thoracic Surgery (Fujian Medical University), Fujian Province University, Fuzhou, Fujian, PR China; Fujian Provincial Center for Cardiovascular Medicine, Fuzhou, Fujian, PR China.
Int J Cardiol. 2024 Sep 1;410:132182. doi: 10.1016/j.ijcard.2024.132182. Epub 2024 May 14.
This study aimed to assess the early- and mid-term outcomes of aortic root repair and replacement, and to provide evidence to improve root management in acute type A aortic dissection (AAAD).
This study enrolled 455 patients who underwent AAAD root repair (n = 307) or replacement (n = 148) between January 2016 and December 2017. Inverse probability of treatment weighting (IPTW) method was used to control for treatment selection bias. The primary outcomes were in-hospital mortality, mid-term survival, and proximal aortic reintervention.
The success rate of root repair was 99.7%. The in-hospital mortality in the conservative root repair (CRR) and aggressive root replacement (ARR) were 8.1% and 10.8%. The median follow-up time was 67.76 months (IQR, 67-72 months). After adjusting for baseline factors, there was no significant differences in mid-term survival (p = .750) or the proximal aortic reintervention rate (p = .550) between the two groups. According to Cox analysis, age, hypertension, severe aortic regurgitation, CPB time, and concomitant CABG were all factors associated with mid-term mortality. Regarding reintervention, multivariate analysis identified renal insufficiency, bicuspid aortic valve, root diameter ≥ 45 mm, and severe aortic regurgitation as risk factors, while CRR did not increase the risk of reintervention. The subgroup analysis revealed heterogeneity in the effects of surgical treatment across diverse populations based on a variety of risk factors.
For patients with AAAD, both CRR and ARR are appropriate operations with promising early and mid-term outcomes. The effects of treatment show heterogeneity across diverse populations based on various risk factors.
本研究旨在评估急性 A 型主动脉夹层（AAAD）患者行主动脉根部修复和置换的早期和中期结果，并为改善根部管理提供证据。
本研究纳入了 2016 年 1 月至 2017 年 12 月期间接受 AAAD 根部修复（n=307）或置换（n=148）的 455 例患者。采用逆概率治疗加权（IPTW）法控制治疗选择偏倚。主要结局为院内死亡率、中期生存率和近端主动脉再介入。
根部修复的成功率为 99.7%。保守性根部修复（CRR）和激进性根部置换（ARR）的院内死亡率分别为 8.1%和 10.8%。中位随访时间为 67.76 个月（IQR，67-72 个月）。调整基线因素后，两组患者的中期生存率（p=0.750）或近端主动脉再介入率（p=0.550）均无显著差异。Cox 分析显示，年龄、高血压、严重主动脉瓣反流、CPB 时间和同期 CABG 是与中期死亡率相关的因素。关于再介入，多变量分析确定肾功能不全、二叶式主动脉瓣、根部直径≥45mm 和严重主动脉瓣反流为危险因素，而 CRR 并未增加再介入的风险。亚组分析显示，基于各种危险因素，不同人群的手术治疗效果存在异质性。
对于 AAAD 患者，CRR 和 ARR 都是可行的手术，具有良好的早期和中期结果。治疗效果在不同人群中存在异质性，这取决于各种危险因素。
