Chen Bailang, Huang Kunpeng, Zhuang Xianmian, Wang Zanxin, Wei Minxin
Department of Cardiovascular Surgery, The University of Hong Kong-Shenzhen Hospital, Shenzhen, Guangdong, China.
Department of Medicine, Shenzhen University, Shenzhen, Guangdong, China.
Front Cardiovasc Med. 2024 May 10;11:1360830. doi: 10.3389/fcvm.2024.1360830. eCollection 2024.
Inadequate remodeling of residual aortic dissection (RAD) following repair of Stanford A or B aortic dissections has been identified as a significant predictor of patient mortality. This study evaluates the short- to mid-term outcomes of staged reinterventions for RAD at a single center with prospective follow-up.
Data were retrospectively collected from patients with RAD who underwent staged reinterventions or received none-surgery treatment in the Cardiovascular Surgery Department of our hospital between July 2019 and December 2021. The cohort included 54 patients with residual distal aortic dissection post-primary surgery, comprising 28 who underwent open surgery and 26 who received thoracic endovascular aortic repair (TEVAR). Patients were divided into two groups: those who underwent staged stent interventions for distal dissection [staged reintervention (SR) group] and those who did not undergo surgery (non-surgery group). For the SR group, second or third staged stent interventions were performed. The study assessed distal remodeling of aortic dissection between the groups, focusing on endpoints such as mortality (both general and aortic-specific), occurrences of visceral branch occlusion, necessity for further interventions, and significant adverse events. Morphological changes were analyzed to determine the therapeutic impact.
The study encompassed 54 participants, with 33 in the SR group and 21 in the non-surgical control group. Baseline demographics and clinical characteristics were statistically comparable across both groups. During an average follow-up of 31.5 ± 7.0 months, aortic-related mortality was 0% in both groups; all-cause mortality was 3% (one case) and 5% (one case) in the SR and control groups, respectively, with no statistically significant difference noted. In the SR group, a single patient experienced complications, including renal artery thrombosis, leading to diminished blood flow. An increased true lumen (TL) area and a decreased false lumen area at various aortic planes were observed in the SR group compared to the control group.
The staged reintervention strategy for treating RAD is safe and provides promising early results.
斯坦福A型或B型主动脉夹层修复术后残余主动脉夹层（RAD）重塑不足已被确定为患者死亡率的重要预测因素。本研究评估了在单一中心进行前瞻性随访的RAD分期再干预的短期至中期结果。
回顾性收集2019年7月至2021年12月期间在我院心血管外科接受分期再干预或非手术治疗的RAD患者的数据。该队列包括54例初次手术后残留远端主动脉夹层的患者，其中28例行开放手术，26例行胸主动脉腔内修复术（TEVAR）。患者分为两组：接受远端夹层分期支架干预的患者[分期再干预（SR）组]和未接受手术的患者（非手术组）。对于SR组，进行了第二次或第三次分期支架干预。该研究评估了两组之间主动脉夹层的远端重塑情况，重点关注死亡率（总体死亡率和主动脉特异性死亡率）、内脏分支闭塞的发生率、进一步干预的必要性以及重大不良事件等终点。分析形态学变化以确定治疗效果。
该研究共纳入54名参与者，其中SR组33名，非手术对照组21名。两组的基线人口统计学和临床特征在统计学上具有可比性。在平均31.5±7.0个月的随访期间，两组的主动脉相关死亡率均为0%；SR组和对照组的全因死亡率分别为3%（1例）和5%（1例），差异无统计学意义。在SR组中，1例患者出现并发症，包括肾动脉血栓形成，导致血流减少。与对照组相比，SR组在不同主动脉平面的真腔（TL）面积增加，假腔面积减小。
治疗RAD的分期再干预策略是安全的，并提供了有希望的早期结果。
