Perioperative and long-term outcomes of surgical treatment for penetrating aortic ulcer in the aortic arch: A retrospective cohort analysis

IF 2.7 3区医学 Q1 SURGERY

American journal of surgery Pub Date : 2025-05-09 DOI:10.1016/j.amjsurg.2025.116406

Luchen Wang, Yanxiang Liu, Bowen Zhang, Sangyu Zhou, Ruojin Zhao, Mingxin Xie, Xuyang Chen, Haoyu Gu, Cuntao Yu, Yaojun Dun, Xiaogang Sun

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Abstract

Objective

This study was designed to evaluate the perioperative and long-term outcomes of surgical treatment, including open and hybrid repairs, for patients with penetrating aortic ulcer (PAU) in the aortic arch.

Methods

A single-center retrospective analysis from China was conducted on 72 patients with PAU in the aortic arch who underwent surgical treatment including open and hybrid repairs between January 2010 and December 2022. The study included 10 patients in the urgent repair group and 62 patients in the elective repair group. The primary endpoints included major adverse events and long-term survival. Major adverse events included in-hospital mortality, reoperation for bleeding, stroke, paraplegia, and acute renal failure.

Results

The rate of major adverse events was 13.9 % (10/72), with an in-hospital mortality rate of 2.8 % (2/72). The mean follow-up period was 69 months. The overall survival rates at 1, 5, and 7 years after surgery were 95.8 %, 91.8 %, and 86.0 %, respectively. Subgroup and regression analyses showed that urgent repair was not significantly associated with the occurrence of major adverse events and long-term survival. Age (OR: 1.12, 95 % CI: 1.00–1.26; P = 0.042) and diabetes (OR: 5.98, 95 % CI: 1.01–35.32; P = 0.048) were found to be independent risk factors for major adverse events as well as NYHA grade ≥ III (HR: 14.68, 95 % CI: 2.11–102.10; P = 0.007) and diabetes (HR: 5.39, 95 % CI: 1.10–26.37; P = 0.038) proved to be independent risk factors for overall survival. Compared to the elective repair group, patients who underwent urgent repair had larger PAUs (P = 0.052), more frequent localization in Zone 0 or Zone 1 (P = 0.038), and were more likely to undergo open surgery, particularly total arch replacement with frozen elephant trunk (P = 0.001). They also experienced longer cardiopulmonary bypass time (P = 0.004), lower minimum temperature (P = 0.001), and lower total expenditure (P < 0.001).

Conclusions

The surgical management of PAU in the aortic arch using open or hybrid repair techniques appears to be feasible, with favorable perioperative and long-term outcomes. However, heightened vigilance may be required for elderly patients, diabetic patients, and those with cardiac insufficiency.

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主动脉弓穿孔性主动脉溃疡手术治疗的围手术期和远期疗效：回顾性队列分析

目的本研究旨在评估主动脉弓穿透性主动脉溃疡（PAU）患者的围手术期和长期预后，包括开放式和混合式修复。方法对2010年1月至2022年12月在中国接受开放和混合修复手术治疗的72例主动脉弓PAU患者进行单中心回顾性分析。本研究纳入紧急修复组10例，择期修复组62例。主要终点包括主要不良事件和长期生存。主要不良事件包括院内死亡、出血再手术、中风、截瘫和急性肾功能衰竭。结果主要不良事件发生率为13.9%(10/72)，住院死亡率为2.8%（2/72）。平均随访69个月。术后1年、5年和7年的总生存率分别为95.8%、91.8%和86.0%。亚组分析和回归分析显示，紧急修复与主要不良事件的发生和长期生存无显著相关。年龄(OR: 1.12, 95% CI: 1.00-1.26；P = 0.042)和糖尿病(OR: 5.98, 95% CI: 1.01-35.32；P = 0.048)为主要不良事件的独立危险因素，NYHA分级≥III级(HR: 14.68, 95% CI: 2.11 ~ 102.10；P = 0.007)和糖尿病(HR: 5.39, 95% CI: 1.10-26.37；P = 0.038)被证明是总生存的独立危险因素。与选择性修复组相比，接受紧急修复的患者PAUs更大（P = 0.052），更频繁地定位于0区或1区（P = 0.038），更有可能进行开放手术，特别是冷冻象鼻全弓置换术（P = 0.001）。他们还经历了更长的体外循环时间（P = 0.004），更低的最低体温（P = 0.001）和更低的总消耗(P <；0.001)。结论采用开放式或混合式修复技术治疗主动脉弓PAU是可行的，围手术期和远期疗效良好。然而，老年患者、糖尿病患者和心功能不全患者可能需要提高警惕。

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

American journal of surgery 医学-外科

CiteScore

5.00

自引率

6.70%

发文量

570

审稿时长

56 days

期刊介绍： The American Journal of Surgery® is a peer-reviewed journal designed for the general surgeon who performs abdominal, cancer, vascular, head and neck, breast, colorectal, and other forms of surgery. AJS is the official journal of 7 major surgical societies* and publishes their official papers as well as independently submitted clinical studies, editorials, reviews, brief reports, correspondence and book reviews.