Soynov Ilya A, Rzayeva Ksenya A, Gorbatykh Yuriy N, Kulyabin Yuriy Y, Gorbatykh Artem V, Velyukhanov Ilya A, Nichay Nataliya R, Manukian Serezha N, Magbulova Saihuna A, Arkhipov Aleksey N, Bogachev-Prokophiev Aleksander V
Federal State Budgetary Institution, Meshalkin National Medical Research Center, Ministry of Health of the Russian Federation, Russia.
Federal State Budgetary Institution, Almazov National Medical Research Center, Ministry of Health of the Russian Federation, Russia.
J Saudi Heart Assoc. 2024 Oct 13;36(3):305-315. doi: 10.37616/2212-5043.1396. eCollection 2024.
The search for the "Holy Grail" of surgical repair for aortic coarctation involves finding an access and correction method that successfully and consistently avoids aortic recoarctation and arterial hypertension. The controversy persists as there is still no consensus on the best surgical approach and technique to achieve these objectives.
The objective of this study is to compare sternotomy and left thoracotomy as surgical techniques for treating patients with aortic coarctation and hypoplasia of the distal aortic arch.
From January 2008 to December 2020, 103 surgical procedures were performed using an extended oblique anastomosis. The patients were divided into 2 groups: oblique, extended anastomosis from thoracotomy access (n-68; 66%) and oblique extended anastomosis from sternotomy access (n-35; 34%). After performing a propensity score analysis (1:1) for the entire sample, 25 patients from sternotomy access were matched with 25 patients from thoracotomy access.
The mortality rate in the thoracotomy group was 4%, with 1 patient, while it was 8% with 2 patients in the sternotomy group, p > 0.99. There were no significant differences in early postoperative complications between the two groups. Recurrence of aortic coarctation was observed more frequently in the thoracotomy group (20.8% vs 0%). Low weight was identified as the only risk factor for aortic re-coarctation.
The mortality rates and early postoperative complications associated with the surgical repair of aortic coarctation were similar between the sternotomy and thoracotomy approaches. Nevertheless, sternotomy approach may be beneficial in reducing aortic recoarctation.
寻找主动脉缩窄手术修复的“圣杯”涉及找到一种能够成功且持续避免主动脉再缩窄和动脉高血压的入路及矫正方法。由于对于实现这些目标的最佳手术方法和技术仍未达成共识，争议一直存在。
本研究的目的是比较胸骨切开术和左胸切开术作为治疗主动脉缩窄和主动脉弓远端发育不全患者的手术技术。
2008年1月至2020年12月，采用延长斜行吻合术进行了103例手术。患者分为2组：经胸切开术入路的斜行、延长吻合术（n = 68；66%）和经胸骨切开术入路的斜行延长吻合术（n = 35；34%）。对整个样本进行倾向评分分析（1:1）后，将25例胸骨切开术入路的患者与25例胸切开术入路的患者进行匹配。
胸切开术组的死亡率为4%，有1例患者死亡，而胸骨切开术组为8%，有2例患者死亡，p>0.99。两组术后早期并发症无显著差异。胸切开术组主动脉缩窄复发更为常见（20.8%对0%）。低体重被确定为主动脉再缩窄的唯一危险因素
胸骨切开术和胸切开术治疗主动脉缩窄的死亡率和术后早期并发症相似。然而，胸骨切开术可能有助于减少主动脉再缩窄。
