Predictors of Lethality, Remodeling, and Aorta-Related Events in Different Types of Proximal Aortic Dissection Surgery.

IF 1.1 Q4 MEDICINE, RESEARCH & EXPERIMENTAL
Sovremennye Tehnologii v Medicine Pub Date : 2023-01-01 Epub Date: 2023-01-28 DOI:10.17691/stm2023.15.1.05
D A Sirota, М О Zhulkov, D S Khvan, T Caus, B N Kozlov, V L Lukinov, М М Lyashenko, A G Makaev, A V Protopopov, Kh A Agaeva, A V Fomichev, S A Мagbulova, A D Limansky, A М Chernyavsky
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引用次数: 0

Abstract

The aim of the study is to analyze predictors of lethality, false lumen thrombosis, enlargement of aortic diameter, and frequency of aorta-related events in the early and remote postoperative periods for various types of proximal aortic dissection surgery using the logistic regression method.

Materials and methods: A retrospective observational comparison of the results of surgical treatment of 213 patients with the diagnosis of "DeBakey type I aortic dissection" has been carried out. The participants were divided into three groups: group 1 underwent classic aortic arch reconstruction using hemiarch technique or total reconstruction of the aortic arch with a multiple-branch prosthesis (n=121); group 2 was subjected to the hemiarch technique and implantation of bare-metal (uncoated) stents (n=55); in group 3, the "frozen elephant trunk" correction technique was used (n=37). The diagnosis of all patients included into the study was preoperatively confirmed by ultrasound and tomographic examination. Predictors of negative events have been identified by building the models of logistic regressions.

Results: The multivariate model of logistic regression has revealed multiplicative significant predictors of lethality: postoperative neurological complications increased the probability of lethality by 3.39 (1.24-9.18) times and presence of a patent false lumen by 4.17 (1.49-13.68) times.Among the predictors of aorta-related events, the most important were connective tissue diseases (the probability increased by 6.68 (2.98-15.62) times), presence of partial thrombosis of the false lumen (the probability of event development increased by 2.39 (1.07-5.44) times), and aortic valve repair (the probability aorta-event occurrence increased by 2.84 (1.13-7.17) times).Hybrid prosthesis implantation appeared to be the most significant predictor of false lumen thrombosis increasing its probability by 4.19 (1.90-9.44) times among aortic repair methods, while a bare-metal stent implantation in contrast reduced the likelihood of false lumen thrombosis by 0.17 (0.03-0.62) times. Eventually, the type of repair had not any significant impact on the aorta-related events and lethality in the long-term period.

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不同类型近端主动脉夹层手术中死亡率、重塑和主动脉相关事件的预测因素
该研究旨在使用逻辑回归法分析各种类型近端主动脉夹层手术的致死率、假腔血栓形成、主动脉直径扩大以及术后早期和远期主动脉相关事件发生频率的预测因素:对确诊为 "DeBakey I型主动脉夹层 "的213名患者的手术治疗结果进行了回顾性观察比较。参与者被分为三组:第一组采用半拱技术进行传统主动脉弓重建,或使用多支假体进行主动脉弓全重建(121人);第二组采用半拱技术并植入裸金属(无涂层)支架(55人);第三组采用 "冰冻象鼻 "矫正技术(37人)。所有纳入研究的患者均在术前通过超声波和断层扫描检查确诊。通过建立逻辑回归模型确定了不良事件的预测因素:结果:逻辑回归的多变量模型揭示了死亡的多重显著预测因素:术后神经并发症使死亡概率增加 3.39(1.24-9.18)倍,假腔通畅使死亡概率增加 4.17(1.49-13.68)倍。在主动脉相关事件的预测因素中,最重要的是结缔组织疾病(概率增加了 6.68 (2.98-15.62) 倍)、假腔部分血栓形成(事件发生概率增加了 2.在主动脉修复方法中,混合假体植入似乎是预测假腔血栓形成的最重要因素,其概率增加了 4.19(1.90-9.44)倍,而裸金属支架植入则将假腔血栓形成的概率降低了 0.17(0.03-0.62)倍。最终,修复类型对主动脉相关事件和长期致死率没有明显影响。
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来源期刊
Sovremennye Tehnologii v Medicine
Sovremennye Tehnologii v Medicine MEDICINE, RESEARCH & EXPERIMENTAL-
CiteScore
1.80
自引率
0.00%
发文量
38
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