Outcomes of descending and thoracoabdominal aortic repair in connective tissue disorder patients.

IF 16.4 1区 化学 Q1 CHEMISTRY, MULTIDISCIPLINARY
Magnus Jonsson, Linus Blohmé, Alireza Daryapeyma, Anders Günther, Göran Lundberg, Lena Nilsson, Carl-Magnus Wahlgren, Anders Franco-Cereceda, Christian Olsson
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引用次数: 1

Abstract

Objectives: Open surgical repair (OSR) of descending and thoracoabdominal aortic aneurysms carries risks of mortality and major complications. Patients with connective tissue disorders (CTD) are younger and require safe, efficient treatment with long-term durability. This study provides current outcome data to help inform treatment decisions.

Methods: All OSRs of descending thoracic aortic aneurysm (DTAA) or thoracoabdominal aortic aneurysm (TAAA) from January 2011 to July 2021 were included in a retrospective cohort study. Primary outcome measures were early and follow-up mortality and reintervention. Secondary outcome measures were major complications. Kaplan-Meier methods were used to estimate reintervention-free survival.

Results: A total of 26 OSRs (7 DTAA, 19 TAAA) were performed in 23 patients: 20 (77%) Marfan and 6 (23%) Loeys-Dietz syndrome; median age 43 years. Aortic dissection was present in 100% and 3/26 (12%) were urgent. Early mortality was 1/26 (3.8%). No patient suffered spinal cord ischemia, stroke, vocal cord paralysis, or re-exploration for bleeding. The transient respiratory failure occurred in 19% (5/26) and transient renal replacement therapy in 15% (4/26). Renal function normalized in all patients within 3 months. During follow-up (median 4.6, range 0-11 years) there were no deaths and only one re-intervention on a previously operated aortic segment, resulting in 92% reintervention-free survival at 5 years.

Conclusions: In dedicated units, open surgical DTAA and TAAA repair in patients with CTD can be performed with a very low risk of death, severe complications and, late re-intervention. For CTD patients with reasonable risk, OSR should remain the first line of treatment.

结缔组织疾病患者降腹主动脉和胸腹主动脉修复的疗效。
目的:下行和胸腹主动脉瘤的开放式手术修复(OSR)存在死亡和主要并发症的风险。结缔组织疾病(CTD)患者较年轻,需要安全、有效的长期治疗。这项研究提供了当前的结果数据,以帮助指导治疗决策。方法:2011年1月至2021年7月,所有降胸主动脉瘤(DTAA)或胸腹主动脉瘤(TAAA)的osr纳入回顾性队列研究。主要结局指标为早期和随访死亡率及再干预。次要结局指标为主要并发症。Kaplan-Meier方法用于估计无再干预生存期。结果:23例患者共行OSRs 26例(DTAA 7例,TAAA 19例),其中Marfan综合征20例(77%),Loeys-Dietz综合征6例(23%);平均年龄43岁。100%存在主动脉夹层,3/26(12%)为急诊。早期死亡率为1/26(3.8%)。没有患者出现脊髓缺血、中风、声带麻痹或再次探查出血。短暂性呼吸衰竭发生率为19%(5/26),短暂性肾脏替代治疗发生率为15%(4/26)。所有患者肾功能在3个月内恢复正常。在随访期间(中位4.6年,0-11年),无死亡,仅有一次对先前手术的主动脉段进行再干预,5年无再干预生存率为92%。结论:在专门的科室,开放式手术DTAA和TAAA修复CTD患者的死亡风险极低,并发症严重,且再干预时间较晚。对于有合理风险的CTD患者,OSR仍应作为一线治疗。
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
Accounts of Chemical Research
Accounts of Chemical Research 化学-化学综合
CiteScore
31.40
自引率
1.10%
发文量
312
审稿时长
2 months
期刊介绍: Accounts of Chemical Research presents short, concise and critical articles offering easy-to-read overviews of basic research and applications in all areas of chemistry and biochemistry. These short reviews focus on research from the author’s own laboratory and are designed to teach the reader about a research project. In addition, Accounts of Chemical Research publishes commentaries that give an informed opinion on a current research problem. Special Issues online are devoted to a single topic of unusual activity and significance. Accounts of Chemical Research replaces the traditional article abstract with an article "Conspectus." These entries synopsize the research affording the reader a closer look at the content and significance of an article. Through this provision of a more detailed description of the article contents, the Conspectus enhances the article's discoverability by search engines and the exposure for the research.
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