Aortic arch surgery for DeBakey type 1 aortic dissection in patients aged 60 years or younger.

IF 3.5 3区 医学 Q1 SURGERY
BJS Open Pub Date : 2024-05-08 DOI:10.1093/bjsopen/zrae047
Fausto Biancari, Javier Rodriguez Lega, Giovanni Mariscalco, Sven Peterss, Joscha Buech, Antonio Fiore, Andrea Perrotti, Andreas Rukosujew, Angel G Pinto, Till Demal, Konrad Wisniewski, Marek Pol, Giuseppe Gatti, Igor Vendramin, Mauro Rinaldi, Robert Pruna-Guillen, Dario Di Perna, Zein El-Dean, Hiwa Sherzad, Francesco Nappi, Mark Field, Matteo Pettinari, Mikko Jormalainen, Angelo M Dell'Aquila, Francesco Onorati, Eduard Quintana, Tatu Juvonen, Timo Mäkikallio
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Abstract

Background: Extended aortic repair is considered a key issue for the long-term durability of surgery for DeBakey type 1 aortic dissection. The risk of aortic degeneration may be higher in young patients due to their long life expectancy. The early outcome and durability of aortic surgery in these patients were investigated in the present study.

Methods: The subjects of the present analysis were patients under 60 years old who underwent surgical repair for acute DeBakey type 1 aortic dissection at 18 cardiac surgery centres across Europe between 2005 and 2021. Patients underwent ascending aortic repair or total aortic arch repair using the conventional technique or the frozen elephant trunk technique. The primary outcome was 5-year cumulative incidence of reoperation on the distal aorta.

Results: Overall, 915 patients underwent surgical ascending aortic repair and 284 patients underwent surgical total aortic arch repair. The frozen elephant trunk procedure was performed in 128 patients. Among 245 propensity score-matched pairs, total aortic arch repair did not decrease the rate of distal aortic reoperation compared to ascending aortic repair (5-year cumulative incidence, 6.7% versus 6.7%, subdistributional hazard ratio 1.127, 95% c.i. 0.523 to 2.427). Total aortic arch repair increased the incidence of postoperative stroke/global brain ischaemia (25.7% versus 18.4%, P = 0.050) and dialysis (19.6% versus 12.7%, P = 0.003). Five-year mortality was comparable after ascending aortic repair and total aortic arch repair (22.8% versus 27.3%, P = 0.172).

Conclusions: In patients under 60 years old with DeBakey type 1 aortic dissection, total aortic arch replacement compared with ascending aortic repair did not reduce the incidence of distal aortic operations at 5 years. When feasible, ascending aortic repair for DeBakey type 1 aortic dissection is associated with satisfactory early and mid-term outcomes.

Trial registration: ClinicalTrials.gov Identifier: NCT04831073.

为 60 岁或以下的 DeBakey 1 型主动脉夹层患者实施主动脉弓手术。
背景:延长主动脉修补术被认为是 DeBakey 1 型主动脉夹层手术长期耐久性的关键问题。年轻患者由于预期寿命长,主动脉变性的风险可能更高。本研究调查了这些患者主动脉手术的早期结果和耐久性:本次分析的对象是 2005 年至 2021 年期间在欧洲 18 个心脏外科中心接受急性 DeBakey 1 型主动脉夹层手术修复的 60 岁以下患者。患者采用传统技术或冷冻象鼻技术接受了升主动脉修复术或全主动脉弓修复术。主要结果是远端主动脉5年累计再手术发生率:结果:共有 915 名患者接受了升主动脉修复手术,284 名患者接受了全主动脉弓修复手术。128名患者接受了冷冻象鼻手术。在245对倾向得分匹配的患者中,与升主动脉修复术相比,全主动脉弓修复术并没有降低远端主动脉再手术率(5年累计发生率,6.7%对6.7%,亚分布危险比1.127,95% c.i.0.523对2.427)。全主动脉弓修补术增加了术后中风/全脑缺血(25.7% 对 18.4%,P = 0.050)和透析(19.6% 对 12.7%,P = 0.003)的发生率。升主动脉修补术和全主动脉弓修补术的五年死亡率相当(22.8% 对 27.3%,P = 0.172):结论:对于60岁以下的DeBakey 1型主动脉夹层患者,与升主动脉修复术相比,全主动脉弓置换术并不能降低5年后远端主动脉手术的发生率。在可行的情况下,升主动脉修补术治疗 DeBakey 1 型主动脉夹层可获得令人满意的早期和中期疗效:试验注册:ClinicalTrials.gov Identifier:试验注册:ClinicalTrials.gov Identifier:NCT04831073。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
BJS Open
BJS Open SURGERY-
CiteScore
6.00
自引率
3.20%
发文量
144
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