Fausto Biancari, Giuseppe Gatti, Timo Mäkikallio, Tatu Juvonen, Giovanni Mariscalco, Zein El-Dean, Matteo Pettinari, Javier Rodriguez Lega, Andrea Perrotti, Francesco Onorati, Konrad Wisniewki, Till Demal, Petr Kacer, Dario Di Perna, Igor Vendramin, Mauro Rinaldi, Luisa Ferrante, Eduard Quintana, Joscha Buech, Caroline Radner, Antonio Fiore, Angelo M Dell'Aquila, Paola D'Errigo, Stefano Rosato, Gianluca Polvani, Sven Peterss
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In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study.</p><p><strong>Results: </strong>Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). 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引用次数: 0
摘要
背景：广泛手术切除A型主动脉夹层（TAAD）患者的胸主动脉被认为可以降低晚期主动脉壁退变的风险和重复主动脉手术的需要。目的：我们评估累及主动脉根部的TAAD患者主动脉根部置换术和冠状上升主动脉置换术的早期和晚期预后。设计：回顾性、多中心队列研究。方法：对累及主动脉根部的TAAD患者进行主动脉根部置换术和冠状上升主动脉置换术后的结果进行评价，主动脉根部是指位于至少一个Valsava节段的夹层皮瓣。住院死亡率、神经系统并发症、透析以及10年重复主动脉近端手术和死亡率是本研究的结果。结果：冠状上升主动脉置换术198例，主动脉根置换术215例。在平均4.0±4.0年的随访期间，19例患者接受了22次主动脉根部和/或主动脉瓣重复手术。再干预后无手术死亡。行主动脉根置换术的患者主动脉近端再手术的风险显著降低（5.5% vs 12.9%，调整亚分布风险比（SHR） 0.085, 95% CI 0.022-0.329）。主动脉根部置换术与较高的住院率（14.4% vs 12.1%，校正优势比2.192,95% CI 1.000-4.807）和10年死亡率（44.5% vs 30.4%，校正危险比2.216,95% CI 1.338-3.671）相关。术后神经系统并发症和透析率在各研究组间具有可比性。结论：在累及主动脉根部的TAAD患者中，与冠状动脉上动脉置换术相比，其置换术与任何类型的主动脉近端重复手术的发生率均显著降低。尽管如此，主动脉根部置换术似乎与这些患者死亡风险的增加有关。
Ascending aortic replacement versus aortic root replacement in patients with type A aortic dissection involving the aortic root.
Background: Extensive surgical resection of the thoracic aorta in patients with type A aortic dissection (TAAD) is thought to reduce the risk of late aortic wall degeneration and the need for repeat aortic operations.
Objectives: We evaluated the early and late outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root.
Design: Retrospective, multicenter cohort study.
Methods: The outcomes after aortic root replacement and supracoronary ascending aortic replacement in patients with TAAD involving the aortic root, that is dissection flap located at least in one of the Valsava segments, were herein evaluated. In-hospital mortality, neurological complications, dialysis as well as 10-year repeat proximal aortic operation, and mortality were the outcomes of this study.
Results: Supracoronary ascending aortic replacement was performed in 198 patients and aortic root replacement in 215 patients. During a mean follow-up of 4.0 ± 4.0 years, 19 patients underwent 22 repeat procedures on the aortic root and/or aortic valve. No operative death occurred after these reinterventions. The risk of proximal aortic reoperation was significantly lower in patients who underwent aortic root replacement (5.5% vs 12.9%, adjusted subdistributional hazard ratio (SHR) 0.085, 95% CI 0.022-0.329). Aortic root replacement was associated with higher rates of in-hospital (14.4% vs 12.1%, adjusted odds ratio 2.192, 95% CI 1.000-4.807) and 10-year mortality (44.5% vs 30.4%, adjusted hazard ratio 2.216, 95% CI 1.338-3.671). Postoperative neurological complications and dialysis rates were comparable in the study groups.
Conclusion: Among patients with TAAD involving the aortic root, its replacement was associated with a significantly lower rate of repeat proximal aortic operation of any type compared to supracoronary aortic replacement. Still, aortic root replacement seems to be associated with an increased risk of mortality in these patients.
期刊介绍：
The journal is aimed at clinicians and researchers from the cardiovascular disease field and will be a forum for all views and reviews relating to this discipline.Topics covered will include: ·arteriosclerosis ·cardiomyopathies ·coronary artery disease ·diabetes ·heart failure ·hypertension ·metabolic syndrome ·obesity ·peripheral arterial disease ·stroke ·arrhythmias ·genetics
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