Kudo Tomoaki, Kuratani Toru, Sawa Yoshiki, Miyagawa Shigeru
Department of Cardiovascular Surgery, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita 565-0871, Osaka, Japan.
Department of Minimally Invasive Cardiovascular Medicine, Osaka University Graduate School of Medicine, 2-2, Yamadaoka, Suita 565-0871, Osaka, Japan.
J Clin Med. 2025 Aug 18;14(16):5837. doi: 10.3390/jcm14165837.
This study investigated whether branched thoracic endovascular aortic repair (bTEVAR), a treatment for distal aortic arch diseases, could serve as an alternative to open aortic surgery (OAS). This single-center, retrospective, observational cohort study comprised 80 patients (bTEVAR, n = 28; TAR, n = 52) treated from October 2012 to June 2018. The median age and median follow-up periods were 73 years (interquartile range [IQR], 66-79 years) and 6.0 years (IQR, 2.8-9.7 years). The patients in the bTEVAR group were older than those in the OAS group ( < 0.001), and the EuroSCORE2 was significantly higher in the bTEVAR group (6.6%) than in the OAS group (2.4%; < 0.001). There were no 30-day or in-hospital mortalities in either group. Stroke was observed in four (5.0%) patients, all of whom were in the bTEVAR group ( = 0.013). However, no other significant differences were observed between the two groups in other early aortic events. Kaplan-Meier curves regarding the survival, aorta-related death, and aortic events showed no significant differences between the two groups. Although bTEVAR involves an older patient population and a higher surgical risk, the early and mid-term outcomes were comparable to those of OAS, except for cerebral infarction. However, because cerebral infarction significantly reduces a patient's quality of life, for bTEVAR to become more widespread, it is necessary to reduce the incidence of cerebral infarction.
本研究调查了用于治疗主动脉弓远端疾病的分支型胸主动脉腔内修复术（bTEVAR）能否作为开放主动脉手术（OAS）的替代方案。这项单中心、回顾性、观察性队列研究纳入了2012年10月至2018年6月期间接受治疗的80例患者（bTEVAR组，n = 28；OAS组，n = 52）。中位年龄和中位随访期分别为73岁（四分位间距[IQR]，66 - 79岁）和6.0年（IQR，2.8 - 9.7年）。bTEVAR组患者比OAS组患者年龄更大（< 0.001），且bTEVAR组的欧洲心脏手术风险评估系统（EuroSCORE2）显著高于OAS组（6.6%比2.4%；< 0.001）。两组均无30天或住院期间死亡病例。4例（5.0%）患者发生卒中，所有患者均在bTEVAR组（P = 0.013）。然而，两组在其他早期主动脉事件方面未观察到其他显著差异。关于生存、主动脉相关死亡和主动脉事件的Kaplan-Meier曲线显示两组之间无显著差异。尽管bTEVAR涉及的患者年龄较大且手术风险较高，但除脑梗死外，其早期和中期结果与OAS相当。然而，由于脑梗死会显著降低患者的生活质量，为使bTEVAR更广泛应用，有必要降低脑梗死的发生率。
