急性A型主动脉夹层远端吻合口新出现的撕裂：主动脉远端再次手术的一个危险因素。
Distal anastomosis new entry tear in acute type A aortic dissection: A risk factor for distal aortic reoperation.
作者信息
Ahmad Rana-Armaghan, Marway Prabhvir, Campello Jorge Carlos Alberto, Monaghan Katelyn, Satija Divyaam, Ling Carol, Fukuhara Shinichi, Patel Himanshu, Deeb G Michael, Burris Nicholas, Yang Bo
机构信息
Department of Cardiac Surgery, Michigan Medicine, Ann Arbor, Mich.
Department of Radiology, Michigan Medicine, Ann Arbor, Mich.
出版信息
JTCVS Open. 2025 Mar 2;24:77-84. doi: 10.1016/j.xjon.2025.02.016. eCollection 2025 Apr.
OBJECTIVE
To identify predictive factors for the occurrence of a distal anastomosis new entry tear (DANE) in patients who underwent hemiarch replacement after acute type A aortic dissection (ATAAD) and examine the association of DANE with distal aortic reoperation.
METHODS
Between 1996 and March 2021, 434 patients underwent hemiarch replacement for DeBakey I ATAAD, of whom 327 patients had adequate postoperative imaging. Based on the presence of DANE on postoperative computed tomography angiography, patients were divided into the DANE group (n = 81) and the no-DANE group (n = 246). Primary outcomes were the cumulative incidence of distal aortic reoperation and the risk factors for DANE.
RESULTS
Most perioperative characteristics and outcomes, including age, sex, malperfusion syndromes, aortic diameters, and operative mortality were similar in the 2 groups. Using death as a competing factor, the 10-year cumulative incidence of distal aortic reoperation was higher in the DANE group compared to the no-DANE group (30% vs 12%; = .0001). The hazard ratio for DANE in distal reoperations was 2.28 ( = .005). A multivariable regression model showed that having an aortic surgeon was protective against DANE compared to having a nonaortic surgeon (odds ratio [OR], 0.29; = .05) and identified branch dissection (OR, 2.42; = .002) as a risk factor for the occurrence of DANE. Connective tissue disease and large-bore suture (4-0 vs 5-0) were not associated with DANE.
CONCLUSIONS
Optimizing surgical techniques to prevent DANE in ATAAD repair may prevent the need for reoperation on the distal aorta in DeBakey type I ATAAD.
目的
确定急性A型主动脉夹层（ATAAD）患者行半弓置换术后发生远端吻合口新入口撕裂（DANE）的预测因素，并探讨DANE与远端主动脉再次手术的相关性。
方法
1996年至2021年3月，434例患者因DeBakey I型ATAAD接受半弓置换术，其中327例患者术后影像学资料完整。根据术后计算机断层扫描血管造影是否存在DANE，将患者分为DANE组（n = 81）和无DANE组（n = 246）。主要结局为远端主动脉再次手术的累积发生率及DANE的危险因素。
结果
两组患者的大多数围手术期特征和结局相似，包括年龄、性别、灌注不良综合征、主动脉直径和手术死亡率。以死亡作为竞争因素，DANE组远端主动脉再次手术的10年累积发生率高于无DANE组（30%对12%；P = 0.0001）。远端再次手术中DANE的风险比为2.28（P = 0.005）。多变量回归模型显示，与非主动脉外科医生相比，有主动脉外科医生可预防DANE（优势比[OR]，0.29；P = 0.05），并确定分支夹层（OR，2.42；P = 0.002）是发生DANE的危险因素。结缔组织病和大口径缝线（4-0对5-0）与DANE无关。
结论
优化手术技术以预防ATAAD修复术中的DANE，可能避免DeBakey I型ATAAD患者远端主动脉再次手术的需要。
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