主动脉裂孔上方的专利性撕裂闭合与A型主动脉夹层的结局
Closing of a Patent Tear Above the Aortic Hiatus and Type A Aortic Dissection Outcomes.
作者信息
Oda Katsuhiko, Kanda Keisuke, Takahashi Makoto, Terao Naoya, Akanuma Rina, Hasegawa Takahiko, Kawatsu Satoshi
机构信息
Department of Cardiovascular Surgery, Iwate Prefectural Central Hospital, Morioka, Iwate, Japan.
出版信息
Ann Thorac Surg Short Rep. 2023 Jun 7;1(3):375-378. doi: 10.1016/j.atssr.2023.05.014. eCollection 2023 Sep.
BACKGROUND
A strategy combining tear-oriented initial surgical procedure and subsequent thoracic endovascular aortic repair (TEVAR) can be adopted for acute type A aortic dissection (ATAAD). This study investigated this strategy's outcomes and the role of the aortic hiatus (AH).
METHODS
Overall, 192 consecutive patients with ATAAD who underwent initial surgery between 2012 and 2021 were assessed in this observational retrospective study. The reintervention rate, the relationship of the residual tear location above or below the AH, and the outcomes of subsequent TEVAR and redo distal open repair were assessed.
RESULTS
The initial surgery's in-hospital death rate was 8.3%; the subsequent TEVAR and redo distal open repair rates were 28% and 3%, respectively. Reintervention was performed in 93% and 0% of patients with tears above and below the AH, respectively, with a 0% mortality rate.
CONCLUSIONS
In false lumen expansion cases, timely detection and closure of the residual intimal tear above the AH with subsequent TEVAR might improve ATAAD outcomes.
背景
对于急性A型主动脉夹层（ATAAD），可采用以撕裂口为导向的初始外科手术联合后续胸主动脉腔内修复术（TEVAR）的策略。本研究调查了该策略的疗效以及主动脉裂孔（AH）的作用。
方法
在这项观察性回顾性研究中，对2012年至2021年间连续接受初始手术的192例ATAAD患者进行了评估。评估了再次干预率、残余撕裂口位置在AH上方或下方的关系以及后续TEVAR和再次远端开放修复的疗效。
结果
初始手术的院内死亡率为8.3%；后续TEVAR和再次远端开放修复率分别为28%和3%。AH上方和下方有撕裂口的患者再次干预率分别为93%和0%，死亡率为0%。
结论
在假腔扩张病例中，及时发现并闭合AH上方的残余内膜撕裂口，随后进行TEVAR可能会改善ATAAD的治疗效果。
Zotero 插件