Division of Cardiac Surgery, Wessex Cardiothoracic Centre University Hospital Southampton, Southampton SO16 6YD, UK.
Academic Unit of Human Development and Health, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK.
Medicina (Kaunas). 2024 Jul 31;60(8):1245. doi: 10.3390/medicina60081245.
This is a propensity-matched, single-center study of limited versus extended resection for type A acute aortic dissection (AAAD). : This study collected retrospective data for 440 patients with acute type A aortic dissection repairs (limited resection, LR-215; extended resection, ER-225), of which 109 pairs were propensity-matched to LR versus ER. Multivariate analysis was performed for inpatient death, long-term survival and the composite outcome of inpatient death/TIA/stroke. Kaplan-Meier survival curves were compared at 1, 3, 5, 10 and 15 years using the log-rank test. : Mean age was 66.9 ± 13 years and mean follow-up was 5.3 ± 4.7 years. A total of 48.9% had LR. In-hospital mortality was 10% (LR: 6% vs. ER: 13.8%, < 0.01). ER, NYHA class, salvage surgery and additional procedures were predictors of increased mortality in unmatched data. Propensity-matched data showed no difference in TIA/stroke rates, LOS, inpatient mortality or composite outcomes. LR had better survival (LR: 77.1% vs. ER: 51.4%, < 0.001). ER (OR: 1.97, 95% CI: 1.27, 3.08, = 0.003) was a significant predictor of worse long-term survival. At 15 years, aortic re-operation was 17% and freedom from re-operation and death was 42%. : Type A aortic dissection repair has high mortality and morbidity, although results have improved over two decades. ER was a predictor of worse perioperative results and long-term survival.
这是一项关于 A 型急性主动脉夹层（AAAD）局限性与广泛性切除术的倾向匹配、单中心研究。：该研究回顾性收集了 440 例急性 A 型主动脉夹层修复患者的数据（局限性切除，LR-215；广泛性切除，ER-225），其中 109 对进行了倾向匹配以比较 LR 与 ER。对住院死亡、长期生存和住院死亡/TIA/中风的复合结局进行了多变量分析。使用对数秩检验比较了 1、3、5、10 和 15 年的 Kaplan-Meier 生存曲线。：平均年龄为 66.9 ± 13 岁，平均随访时间为 5.3 ± 4.7 年。共有 48.9%的患者接受了 LR。住院死亡率为 10%（LR：6%比 ER：13.8%，<0.01）。在未匹配数据中，ER、NYHA 分级、挽救性手术和附加手术是死亡率增加的预测因素。倾向匹配数据显示，TIA/中风发生率、 LOS、住院死亡率或复合结局无差异。LR 的生存率更好（LR：77.1%比 ER：51.4%，<0.001）。ER（OR：1.97，95%CI：1.27，3.08，=0.003）是长期生存较差的显著预测因素。在 15 年时，主动脉再次手术率为 17%，免于再次手术和死亡的比例为 42%。：A 型主动脉夹层修复的死亡率和发病率较高，尽管在过去二十年中有所改善。ER 是围手术期结果和长期生存较差的预测因素。
