Chen Trina, Kholova Ivana, Paavonen Timo, Mennander Ari
Department of Cardiothoracic Surgery, Tampere University Heart Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
Department of Pathology, Fimlab Laboratories, Tampere University Hospital and Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland.
J Thorac Dis. 2024 Jul 30;16(7):4155-4164. doi: 10.21037/jtd-24-206. Epub 2024 Jul 2.
Aortic root involvement during acute type A aortic dissection (ATAAD) may depend on ascending aortic wall degeneration. Surgical decision-making for extended resection of the aortic root is clinically made without histopathology. The aim of the study was to investigate whether the degree of degeneration of the ascending aortic wall found in patients with ATAAD is associated with the aortic root involvement.
Collectively, 141 consecutive patients undergoing ATAAD surgery at Tampere University Heart Hospital were investigated. The ascending aortic wall resected in surgery was processed for 11 different variables that describe medial and adventitial degeneration. In addition, atherosclerosis and inflammation were separately evaluated. Patients undergoing aortic root replacement were compared with those with supracoronary reconstruction of the ascending aorta with/without aortic valve surgery (root-sparing surgery) during a mean 4.9-year follow-up.
Aortic root replacement together with the ascending aortic replacement was performed in 39% of the patients (n=55). The mean age for all patients was 65 years [standard deviation (SD 13)]. Many patients with aortic root replacement had moderate to severe aortic valve regurgitation (85.5%). Most of the patients with aortic root-sparing surgery included a supracoronary tube prosthesis (89.5%), while nine patients also had aortic valve replacement. The degree of mucoid extracellular matrix accumulation was more prominent in patients with aortic root replacement compared to patients with root-sparing surgery (2.1 SD 0.4 1.9 SD 0.4, P=0.04, respectively). During follow-up, there were 52 deaths among patients (log rank P=0.79).
Histopathology of the ascending aorta during ATAAD reveals distinctive aortic wall degeneration in patients with aortic root involvement not. The degree of mucoid extracellular matrix accumulation assessed postoperatively is associated with the choice of surgical procedure in many patients.
急性A型主动脉夹层（ATAAD）期间主动脉根部受累可能取决于升主动脉壁退变。临床上在没有组织病理学检查的情况下做出主动脉根部扩大切除术的手术决策。本研究的目的是调查ATAAD患者升主动脉壁的退变程度是否与主动脉根部受累相关。
共对坦佩雷大学心脏医院连续141例行ATAAD手术的患者进行了调查。对手术中切除的升主动脉壁进行11个描述中膜和外膜退变的不同变量的处理。此外，分别评估动脉粥样硬化和炎症。在平均4.9年的随访期间，将接受主动脉根部置换的患者与接受升主动脉冠状动脉上重建术（无论是否进行主动脉瓣手术）（保留根部手术）的患者进行比较。
39%的患者（n = 55）同时进行了主动脉根部置换和升主动脉置换。所有患者的平均年龄为65岁[标准差（SD）13]。许多接受主动脉根部置换的患者有中度至重度主动脉瓣反流（85.5%）。大多数保留根部手术的患者包括冠状动脉上人工血管（89.5%），而9例患者也进行了主动脉瓣置换。与保留根部手术的患者相比，主动脉根部置换患者的黏液样细胞外基质积聚程度更明显（分别为2.1 SD 0.4对1.9 SD 0.4，P = 0.04）。随访期间，患者中有52例死亡（对数秩检验P = 0.79）。
ATAAD期间升主动脉的组织病理学显示，主动脉根部受累患者的主动脉壁退变具有独特性。术后评估的黏液样细胞外基质积聚程度与许多患者的手术方式选择相关。
