Frankort Jelle, Frankort Siebe, Doukas Panagiotis, Uhl Christian, Jacobs Michael J, Mees Barend M E, Gombert Alexander
Department of Vascular Surgery, Medical Faculty, RWTH Aachen University, 52074 Aachen, Germany.
Department of Vascular Surgery, MUMC+ Maastricht, 6229 HX Maastricht, The Netherlands.
J Clin Med. 2025 Apr 7;14(7):2513. doi: 10.3390/jcm14072513.
This multicenter study compares outcomes of open thoracoabdominal aortic aneurysm (TAAA) repair in patients < 60 years with (n = 106), versus without (n = 167), hereditary aortopathy. We conducted a retrospective analysis of 273 consecutive open TAAA repairs (2000-2024) at two European centers. The primary endpoint was early outcome. We used a Kaplan-Meier curve to assess survival, and logistic regression to identify predictors. Operative death rates were similar (hereditary: 13/106 [12.3%] vs. non-hereditary: 22/167 [13.2%], = 0.83). Hereditary aortopathy patients were younger (median 42 vs. 54 years, < 0.001) with lower BMI (24.1 vs. 28.4 kg/m, < 0.001). Non-genetic patients had higher rates of chronic kidney insufficiency (58/167 (34.7%) vs. 14/106 (13.2%), < 0.001), coronary artery disease (43/167 (25.7%) vs. 9/106 (8.5%), < 0.001), and prior myocardial infarction (31/167 (18.6%) vs. 4/106 (3.8%), < 0.001). Hereditary aortopathy patients suffered more often from post-dissection TAAA (68/106 [64.2%] vs. 44/167 [26.3%], < 0.001) and prior aortic surgery (81/106 (76.4%) vs. 79/167 (47.3%), < 0.001). Pulmonary complications (67.0% vs. 61.1%, = 0.32), acute kidney injury (25.5% vs. 22.8%, = 0.61), and spinal cord ischemia (6.6% vs. 10.2%, = 0.31) were comparable between groups. Overall 5-year survival was 65.7%; the rate of any reintervention during follow up was 21.2%. Logistic regression identified no predictors for perioperative mortality. Open TAAA repair in patients < 60 years carries relevant perioperative mortality, which is comparable between hereditary and non-hereditary groups; non-hereditary patients had impaired preoperative cardiopulmonary status.
这项多中心研究比较了年龄小于60岁的遗传性主动脉病变患者（n = 106）与无遗传性主动脉病变患者（n = 167）接受胸腹主动脉瘤（TAAA）开放修复术的结果。我们对欧洲两个中心2000年至2024年连续进行的273例TAAA开放修复术进行了回顾性分析。主要终点是早期结果。我们使用Kaplan-Meier曲线评估生存率，并使用逻辑回归来确定预测因素。手术死亡率相似（遗传性：13/106 [12.3%] 对比非遗传性：22/167 [13.2%]，P = 0.83）。遗传性主动脉病变患者更年轻（中位年龄42岁对比54岁，P < 0.001），体重指数更低（24.1对比28.4 kg/m²，P < 0.001）。非遗传性患者慢性肾功能不全发生率更高（58/167 [34.7%] 对比14/106 [13.2%]，P < 0.001）、冠状动脉疾病发生率更高（43/167 [25.7%] 对比9/106 [8.5%]，P < 0.001）以及既往心肌梗死发生率更高（31/167 [18.6%] 对比4/106 [3.8%]，P < 0.001）。遗传性主动脉病变患者术后夹层TAAA更常见（68/106 [64.2%] 对比44/167 [26.3%]，P < 0.001）且既往主动脉手术史更常见（81/106 [76.4%] 对比79/167 [47.3%]，P < 0.001）。两组间肺部并发症（67.0%对比61.1%，P = 0.32）、急性肾损伤（25.5%对比22.8%，P = 0.61）和脊髓缺血（6.6%对比10.2%，P = 0.31）发生率相当。总体5年生存率为65.7%；随访期间任何再次干预的发生率为21.2%。逻辑回归未发现围手术期死亡率的预测因素。年龄小于60岁的患者接受TAAA开放修复术有相关围手术期死亡率，遗传性和非遗传性组相当；非遗传性患者术前心肺功能受损。
