Staniforth Edward, Ttofi Iakovos, Ttofi Jasmina, Perinparajah Vanitha, Vijjhalwar Rohit, Uberoi Raman, Sideso Ediri, Dubey Shirish, Krasopoulos George
Oxford University Medical School, Medical Sciences Division, University of Oxford, Oxford, UK.
Department of Cardiac Surgery, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
J Cardiothorac Surg. 2024 Dec 20;19(1):671. doi: 10.1186/s13019-024-03153-4.
Thoracic aortic aneurysms and dissections provide a complex surgical cohort termed thoracic aortic surgery. Regular follow-up at specialist clinics with cross-sectional imaging is recommended. Identifying risk factors that lead to re-operations as well as the requirement for and appropriate length of follow-up remain points of debate.
Patients undergoing thoracic aortic surgery performed at a single centre from January 2012 to December 2022 were retrospectively reviewed. The clinical information, operative details, histological reports, post-operative outcomes and follow up were collected from electronic patient records. Statistical analysis was performed using Microsoft Excel and R Studio.
409 patients met the inclusion criteria for the study with a median follow-up of 3.8 years (IQR 1.6-7.6). The prevalence of all cause re-operations was 10.8% (n = 44). The median time to re-operation was 1.8 years. 68% of the reoperations occurred within the first 5 years. Multi and univariate logistic regression identified young age, arteritis and/or aortitis as the main risk factors associated with increased risk of re-operation. Connective tissue disease and systemic inflammatory diseases approached but didn't meet statistical significance. Bicuspid aortic valve pathology was associated with reduced risk of re-operation.
Patients undergoing thoracic aortic surgery have a high rate of re-operation. The first 5 years represent a high-risk period and follow-up with cross-sectional imaging during that time by specialist aortic services is essential. Patient with aortitis remain at high risk and should be treated by appropriate by specialist aortic services with subspecialty interest and expertise on treating patients with aortitis.
胸主动脉瘤和夹层形成了一个复杂的手术队列，称为胸主动脉手术。建议在专科诊所进行定期横断面成像随访。识别导致再次手术的风险因素以及随访的必要性和适当时长仍是有争议的问题。
回顾性分析2012年1月至2022年12月在单一中心接受胸主动脉手术的患者。从电子病历中收集临床信息、手术细节、组织学报告、术后结果和随访情况。使用Microsoft Excel和R Studio进行统计分析。
409例患者符合研究纳入标准，中位随访时间为3.8年（四分位间距1.6 - 7.6年）。全因再次手术的发生率为10.8%（n = 44）。再次手术的中位时间为1.8年。68%的再次手术发生在头5年内。多因素和单因素逻辑回归分析确定年轻、动脉炎和/或主动脉炎是与再次手术风险增加相关的主要危险因素。结缔组织病和全身性炎症性疾病接近但未达到统计学意义。二叶式主动脉瓣病变与再次手术风险降低相关。
接受胸主动脉手术的患者再次手术率较高。头5年是高危期，在此期间由专科主动脉服务团队进行横断面成像随访至关重要。患有主动脉炎的患者仍然处于高风险状态，应由对治疗主动脉炎患者有专科兴趣和专业知识的专科主动脉服务团队进行适当治疗。
