Guo Ming Hao, Kölbel Tilo, Le Houerou Thomas, Mesnard Thomas, Sobocinski Jonathan, Nana Petroula, Haulon Stéphan
Department of Cardiac and Vascular Surgery, Aortic Center, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, INSERM UMR_S 999, Université Paris Saclay, Le Plessis-Robinson, France; Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
Department of Vascular Medicine, German Aortic Center, University Heart Center Hamburg, Hamburg, Germany.
J Vasc Surg. 2025 Apr;81(4):806-815.e6. doi: 10.1016/j.jvs.2024.11.039. Epub 2024 Dec 16.
Zone 0 branched thoracic endovascular arch repair (Z0BTEVAR) has emerged as an alternative to open repair for high-risk patients with aortic arch pathology. However, it is unclear how disease characteristics in this population impacts clinical outcomes. The study aimed to compare Z0BTEVAR according to arch disease pathology and to identify potential predictors of postoperative outcomes.
From 2011 to 2023, patients who underwent Z0BTEVAR for chronic aortic dissection (C-AD) or for non-aortic dissection (N-AD) etiology at three European centers were included. The primary outcome was a composite of in-hospital mortality and disabling stroke. Multivariable logistic analyses were conducted to identify independent predictors of the outcomes.
Overall, 213 patients underwent Z0BTEVAR, including 111 patients treated for C-AD and 102 patients treated for N-AD. The median age was 72 years old. Overall composite outcome was 10.3%, higher for patients with N-AD compared with patients with C-AD (15.7% vs 5.4%; P = .01). Similarly, patients with N-AD had more postoperative strokes (17.7% vs 4.5%; P < .01). On multivariable analysis, previous type A aortic dissection was protective for the composite outcome (odds ratio, 0.2; 95% confidence interval, 0.1-0.6), whereas degenerative aneurysm with zone 0 or 1 involvement was predictive of postoperative stroke (odds ratio, 3.7; 95% confidence interval, 1.2-11.8). At 4 years, survival for the N-AD group was 71.8% ± 6.6%, and for the C-AD group was 71.5% ± 6.5% (P = .81).
Z0BTEVAR could be performed with satisfactory short- and mid-term outcomes for high-risk patients, particularly those with previous dissection. Patient selection is important, and continued effort should be placed on minimizing postoperative stroke.
对于患有主动脉弓病变的高危患者，0区分支型胸主动脉腔内弓部修复术（Z0BTEVAR）已成为开放性修复的替代方案。然而，尚不清楚该人群的疾病特征如何影响临床结局。本研究旨在根据主动脉弓疾病病理比较Z0BTEVAR，并确定术后结局的潜在预测因素。
纳入2011年至2023年在三个欧洲中心因慢性主动脉夹层（C-AD）或非主动脉夹层（N-AD）病因接受Z0BTEVAR治疗的患者。主要结局是住院死亡率和致残性卒中的综合指标。进行多变量逻辑分析以确定结局的独立预测因素。
总体而言，213例患者接受了Z0BTEVAR，其中111例因C-AD接受治疗，102例因N-AD接受治疗。中位年龄为72岁。总体综合结局为10.3%，N-AD患者高于C-AD患者（15.7%对5.4%；P = 0.01）。同样，N-AD患者术后卒中更多（17.7%对4.5%；P < 0.01）。多变量分析显示，既往A型主动脉夹层对综合结局有保护作用（比值比，0.2；95%置信区间，0.1 - 0.6），而累及0区或1区的退行性动脉瘤是术后卒中的预测因素（比值比，3.7；95%置信区间，1.2 - 11.8）。4年时，N-AD组生存率为71.8% ± 6.6%，C-AD组生存率为71.5% ± 6.5%（P = 0.81）。
对于高危患者，尤其是既往有夹层的患者，Z0BTEVAR可取得令人满意的短期和中期结局。患者选择很重要，应继续努力将术后卒中降至最低。
