60 岁及以下患者的 Debakey 1 型主动脉夹层主动脉弓手术治疗。
Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger.
机构信息
Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
出版信息
BJS Open. 2024 May 8;8(3). doi: 10.1093/bjsopen/zrae047.
BACKGROUND
Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study.
METHODS
The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta.
RESULTS
Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172).
CONCLUSIONS
In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes.
TRIAL REGISTRATION
ClinicalTrials.gov Identifier: NCT04831073.
背景
对于 DeBakey 1 型主动脉夹层，延长主动脉修复被认为是手术长期耐久性的关键问题。由于年轻患者的预期寿命较长，主动脉退行性变的风险可能更高。本研究调查了这些患者的主动脉手术早期结果和耐久性。
方法
本分析的对象是 2005 年至 2021 年期间在欧洲 18 个心脏手术中心接受手术治疗的急性 DeBakey 1 型主动脉夹层且年龄小于 60 岁的患者。患者接受了升主动脉修复或全主动脉弓修复，使用传统技术或冷冻象鼻技术。主要结局是远端主动脉再手术的 5 年累积发生率。
结果
总体而言，915 例患者接受了升主动脉修复，284 例患者接受了全主动脉弓修复。128 例患者行冷冻象鼻手术。在 245 对倾向评分匹配的患者中，全主动脉弓修复与升主动脉修复相比并未降低远端主动脉再手术的发生率（5 年累积发生率，6.7%对 6.7%，亚分布风险比 1.127，95%置信区间 0.523 至 2.427）。全主动脉弓修复增加了术后中风/全脑缺血（25.7%对 18.4%，P = 0.050）和透析（19.6%对 12.7%，P = 0.003）的发生率。升主动脉修复和全主动脉弓修复后 5 年死亡率相当（22.8%对 27.3%，P = 0.172）。
结论
对于年龄小于 60 岁的 DeBakey 1 型主动脉夹层患者，与升主动脉修复相比，全主动脉弓置换术在 5 年内并未降低远端主动脉手术的发生率。在可行的情况下，DeBakey 1 型主动脉夹层的升主动脉修复与满意的早期和中期结果相关。
试验注册
ClinicalTrials.gov 标识符：NCT04831073。
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