主动脉夹层的象鼻支架冷冻术长期疗效：单中心经验
Long-term outcomes of frozen elephant trunk for aortic dissection: a single-center experience.
作者信息
Kozlov Boris N, Panfilov Dmitri S, Kim Elena B
机构信息
Cardiology Research Institute, Tomsk National Research Medical Centre, Russian Academy of Sciences, Tomsk, 634012, Russian Federation.
出版信息
J Cardiothorac Surg. 2024 Oct 1;19(1):559. doi: 10.1186/s13019-024-03074-2.
BACKGROUND
To date a number of papers analysing outcomes of the frozen elephant trunk (FET) in acute aortic dissection has been published. However, there are limited comparative studies on long-term outcomes of FET in acute and chronic aortic dissection. The objective of the study was to analyze the long-term outcomes after FET procedure for aortic dissection (AD).
METHODS
Between March 2012 and December 2022, a total of 123 FET had been performed for thoracic aortic disease. Patients with aortic dissection (n = 97) were divided into 2 groups: acute (n = 32, 33%) and chronic aortic dissection (n = 65, 67%). Pre-, intra- and postoperative data were retrospectively collected from electronic patient's records, including follow-up data of the analyzed patients.
RESULTS
The incidence of stroke was 3.1%. The delirium rate was up to 9.3% in both groups with a prevalence in chronic aortic dissection (CAD) group without significant differences (P = 0.494). Paraplegia was diagnosed only in CAD patients (n = 2). Respiratory failure and the rate of renal replacement therapy were similar in the studied groups. Re-sternotomy was required in one (3.1%) patient with acute AD and 5 (7.7%) patients with chronic AD (P = 0.416). Overall 30-day mortality in the entire cohort, acute and chronic AD was 13 (13.4%), 7 (21.9%) and 6 (9.2%), respectively (P = 0.097). The overall survival rate at 60 months for the entire cohort, acute and chronic AD was 64.1 ± 5.9%, 62.3 ± 9.1%, 66.5 ± 7%, respectively (P = 0.265). Freedom from unintended distal aortic re-intervention at 60 months for the entire cohort of patients, acute and chronic AD was 74.2 ± 1.5%, 100%, 65.3 ± 2%, respectively (P = 0.355).
CONCLUSIONS
Our experience showed acceptable long-term outcomes after the FET procedure including mortality and re-intervention rate in patients with aortic dissection regardless of acuity of the dissection.
TRIAL REGISTRATION
The study has been registered in Australian and New Zealand Clinical Trial Registry (ACTRN 12618001329257) on August 7, 2018.
背景
迄今为止，已发表了多篇分析急性主动脉夹层中冰冻象鼻术（FET）结果的论文。然而，关于FET在急性和慢性主动脉夹层中长期结果的比较研究有限。本研究的目的是分析主动脉夹层（AD）行FET手术后的长期结果。
方法
2012年3月至2022年12月期间，共对123例因胸主动脉疾病行FET手术。主动脉夹层患者（n = 97）分为2组：急性（n = 32，33%）和慢性主动脉夹层（n = 65，67%）。术前、术中和术后数据通过回顾性收集电子病历获得，包括分析患者的随访数据。
结果
卒中发生率为3.1%。两组谵妄发生率均高达9.3%，慢性主动脉夹层（CAD）组患病率无显著差异（P = 0.494）。仅CAD患者诊断为截瘫（n = 2）。研究组呼吸衰竭和肾脏替代治疗率相似。1例急性AD患者（3.1%）和5例慢性AD患者（7.7%）需要再次开胸手术（P = 0.416）。整个队列、急性和慢性AD的30天总死亡率分别为13例（13.4%）、7例（21.9%）和6例（9.2%）（P = 0.097）。整个队列、急性和慢性AD在60个月时的总生存率分别为64.1±5.9%、62.3±9.1%、66.5±7%（P = 0.265）。整个队列患者、急性和慢性AD在60个月时无意外远端主动脉再次干预的比例分别为74.2±1.5%、100%、65.3±2%（P = 0.355）。
结论
我们的经验表明，FET手术后的长期结果包括死亡率和再次干预率在主动脉夹层患者中是可以接受的，无论夹层的严重程度如何。
试验注册
本研究于2018年8月7日在澳大利亚和新西兰临床试验注册中心（ACTRN 12618001329257）注册。
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