Tian Chuan, Xiao Yutong, Hu Kejian, Shu Chang
Vascular Surgery Center, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 North Lishi Road, West City District, Beijing, China.
Heart Vessels. 2025 May;40(5):426-434. doi: 10.1007/s00380-024-02482-7. Epub 2024 Nov 6.
We aimed to evaluate the false lumen patency and late death outcomes of type II hybrid arch repair for type A aortic dissection (TAAD) using the transaortic (TA) and transfemoral (TF) stent deployment approaches. Patients who underwent type II hybrid arch repair for TAAD between September 2013 and November 2020 were enrolled. False lumen patency (classified as patent false lumen, thrombosed false lumen, or false lumen remodeling) and follow-up death were investigated. Multivariate Cox regression and inverse probability of treatment weighting (IPTW) analyses were used to evaluate the association between the outcomes and stent graft deployment approaches. Of the 129 enrolled patients, 23 (17.8%) and 106 (82.2%) were in the TA and TF groups, respectively. During follow-up (median: 42 months, IQR: 32-82 months), higher risks of patent false lumen (odds ratio [OR]: 4.0, 95% confidence interval [CI]: 1.01-16.6, P = 0.03) and all-cause death (hazards ratio [HR]: 5.8, 95% CI: 1.3-25.8, P = 0.02) were observed in TA group than in TF group. In IPTW analysis, TA group showed consistently higher adjusted risks of patent false lumen (adjusted OR: 4.1, 95% CI: 1.6-10.3, P = 0.003) and all-cause death (adjusted HR: 4.5, 95% CI: 1.1-18.7, P = 0.03) than that of TF group. This study demonstrated the TA and TF deployment approaches related to false lumen patency and survival outcomes after type II hybrid arch repair for TAAD. The TA approach was associated with higher risks of patent false lumen and late death during follow-up. The TF approach should be suggested as the primary choice for stent deployment in type II hybrid arch repair for TAAD.
我们旨在使用经主动脉（TA）和经股动脉（TF）支架置入方法，评估A型主动脉夹层（TAAD）II型杂交主动脉弓修复术后假腔通畅情况和晚期死亡结局。纳入2013年9月至2020年11月期间接受TAAD的II型杂交主动脉弓修复术的患者。研究假腔通畅情况（分为通畅假腔、血栓形成假腔或假腔重塑）和随访死亡情况。采用多变量Cox回归和治疗权重逆概率（IPTW）分析来评估结局与支架移植物置入方法之间的关联。在129例纳入患者中，TA组和TF组分别有23例（17.8%）和106例（82.2%）。在随访期间（中位数：42个月，四分位间距：32 - 82个月），与TF组相比，TA组观察到通畅假腔风险更高（比值比[OR]：4.0，95%置信区间[CI]：1.01 - 16.6，P = 0.03）和全因死亡风险更高（风险比[HR]：5.8，95% CI：1.3 - 25.8，P = 0.02）。在IPTW分析中，TA组显示通畅假腔调整后风险（调整后OR：4.1，95% CI：1.6 - 10.3，P = 0.003）和全因死亡调整后风险（调整后HR：4.5，95% CI：1.1 - 18.7，P = 0.03）始终高于TF组。本研究证明了TAAD的II型杂交主动脉弓修复术后，TA和TF置入方法与假腔通畅情况和生存结局相关。TA方法与随访期间通畅假腔和晚期死亡风险更高相关。对于TAAD的II型杂交主动脉弓修复术，应建议将TF方法作为支架置入的首选。
