Hasami N A, Smulders M, Verkroost M W A, Li W W L, Saouti N, Nauta F J H, Geuzebroek G S C, Heijmen R H
Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands.
Interdiscip Cardiovasc Thorac Surg. 2025 Feb 5;40(2). doi: 10.1093/icvts/ivaf019.
Untreated cases of thoraco-abdominal aortic aneurysms pose significant challenges, often leading to severe morbidity and high mortality. While promising, endovascular treatment is not suitable in all cases, particularly younger patients and those with collagen disorders. This study reports on the contemporary outcomes of open thoraco-abdominal aortic aneurysm repair at our academic medical centre from 2015 to 2023.
All patients with thoraco-abdominal aortic aneurysm (Crawford-Safi Types I-V), including elective and non-elective cases, who underwent open surgical repair between January 2015 and December 2023 were included. Patient characteristics, intraoperative variables and postoperative outcomes were prospectively recorded and analysed retrospectively. The primary end point was operative mortality; secondary end points included rates for spinal cord injury, stroke, tracheostomy, need for dialysis and a comparison of outcomes between elective and non-elective cases.
190 patients (146 elective/44 non-elective) were included, with a mean age of 63.8 years (standard deviation 11.5), and 58% were male. Operative mortality was 7.9%, with 7.5% in elective cases and 9.1% in non-elective cases. Stroke with persisting symptoms at discharge occurred in 5.8% of patients, and tracheostomy was required in 3.7%. Spinal cord injury symptoms were observed in 7.4%, with persistent paraparesis in 2.1% and paraplegia in 1.6% at discharge. Acute kidney injury occurred in 38.4% of patients, with 6.9% requiring dialysis and 3.7% continuing dialysis at discharge.
Open thoraco-abdominal aortic aneurysm surgery, supported by a multidisciplinary team approach and strict perioperative protocols, remains effective in managing this complex patient population, demonstrating low rates of mortality and severe complications.
未治疗的胸腹主动脉瘤病例带来了重大挑战，常常导致严重的发病和高死亡率。虽然血管内治疗前景广阔，但并非适用于所有病例，尤其是年轻患者和患有胶原疾病的患者。本研究报告了2015年至2023年我们学术医疗中心开放手术修复胸腹主动脉瘤的当代结果。
纳入2015年1月至2023年12月期间接受开放手术修复的所有胸腹主动脉瘤患者（克劳福德 - 萨菲I - V型），包括择期和非择期病例。前瞻性记录患者特征、术中变量和术后结果，并进行回顾性分析。主要终点是手术死亡率；次要终点包括脊髓损伤、中风、气管切开术、透析需求率以及择期和非择期病例之间的结果比较。
共纳入190例患者（146例择期/44例非择期），平均年龄63.8岁（标准差11.5），58%为男性。手术死亡率为7.9%，择期病例为7.5%，非择期病例为9.1%。出院时伴有持续症状的中风发生在5.8%的患者中，3.7%的患者需要气管切开术。7.4%的患者出现脊髓损伤症状？出院时持续性轻瘫为2.1%，截瘫为1.6%。38.4%的患者发生急性肾损伤，6.9%的患者需要透析，3.7%的患者出院时仍在透析。
在多学科团队方法和严格的围手术期方案支持下，开放手术修复胸腹主动脉瘤在管理这一复杂患者群体方面仍然有效，死亡率和严重并发症发生率较低。
