PDF(Pubmed)
Abstract：
UNASSIGNED: The study objective was to evaluate the progression of dissected distal aorta in patients with acute type A aortic dissection with malperfusion syndrome treated with endovascular fenestration/stenting and delayed open aortic repair.
UNASSIGNED: From 1996 to 2021, 927 patients presented with acute type A aortic dissection. Of these, 534 had DeBakey I dissection with no malperfusion syndrome and underwent emergency open aortic repair (no malperfusion syndrome group), whereas 97 patients with malperfusion syndrome underwent fenestration/stenting and delayed open aortic repair (malperfusion syndrome group). Sixty-three patients with malperfusion syndrome treated with fenestration/stenting were excluded due to no open aortic repair, including death from organ failure (n = 31), death from aortic rupture (n = 16), and discharged alive (n = 16).
UNASSIGNED: Compared with the no malperfusion syndrome group, the malperfusion syndrome group had more patients with acute renal failure (60% vs 4.3%, P < .001). Both groups had similar aortic root and arch procedures. Postoperatively, the malperfusion syndrome group had similar operative mortality (5.2% vs 7.9%, P = .35) and permanent dialysis (4.7% vs 2.9%, P = .50), but more new-onset dialysis (22% vs 7.7%, P < .001) and prolonged ventilation (72% vs 49%, P < .001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, P = .81) was similar between the malperfusion syndrome and no malperfusion syndrome groups. The descending thoracic aorta growth rate (1.03 vs 0.68 mm/year, P = .001) and abdominal aorta growth rate (0.76 vs 0.59 mm/year, P = .02) were significantly higher in the malperfusion syndrome group. The cumulative incidence of reoperation over 10 years (18% vs 18%, P = .81) and 15-year survival outcome (50% vs 48%, P = .43) were similar between the malperfusion syndrome and no malperfusion syndrome groups.
UNASSIGNED: Endovascular fenestration/stenting followed by delayed open aortic repair was a valid approach for patients with malperfusion syndrome.
UNASSIGNED: From 1996 to 2021, 927 patients presented with acute type A aortic dissection. Of these, 534 had DeBakey I dissection with no malperfusion syndrome and underwent emergency open aortic repair (no malperfusion syndrome group), whereas 97 patients with malperfusion syndrome underwent fenestration/stenting and delayed open aortic repair (malperfusion syndrome group). Sixty-three patients with malperfusion syndrome treated with fenestration/stenting were excluded due to no open aortic repair, including death from organ failure (n = 31), death from aortic rupture (n = 16), and discharged alive (n = 16).
UNASSIGNED: Compared with the no malperfusion syndrome group, the malperfusion syndrome group had more patients with acute renal failure (60% vs 4.3%, P < .001). Both groups had similar aortic root and arch procedures. Postoperatively, the malperfusion syndrome group had similar operative mortality (5.2% vs 7.9%, P = .35) and permanent dialysis (4.7% vs 2.9%, P = .50), but more new-onset dialysis (22% vs 7.7%, P < .001) and prolonged ventilation (72% vs 49%, P < .001). The growth rate of the aortic arch (0.38 vs 0.35 mm/year, P = .81) was similar between the malperfusion syndrome and no malperfusion syndrome groups. The descending thoracic aorta growth rate (1.03 vs 0.68 mm/year, P = .001) and abdominal aorta growth rate (0.76 vs 0.59 mm/year, P = .02) were significantly higher in the malperfusion syndrome group. The cumulative incidence of reoperation over 10 years (18% vs 18%, P = .81) and 15-year survival outcome (50% vs 48%, P = .43) were similar between the malperfusion syndrome and no malperfusion syndrome groups.
UNASSIGNED: Endovascular fenestration/stenting followed by delayed open aortic repair was a valid approach for patients with malperfusion syndrome.
摘要：
■本研究的目的是评估急性A型主动脉夹层伴灌注不良综合征患者经血管内开窗/支架置入和延迟开放主动脉修复术治疗后远端主动脉夹层的进展。
■从1996年到2021年，927例患者出现急性A型主动脉夹层。其中,534例进行DeBakeyI型夹层，无灌注不良综合征，并接受了紧急开放主动脉修复术（无灌注不良综合征组），而97例灌注不良综合征患者接受开窗术/支架置入术和延迟开放主动脉修复术(灌注不良综合征组).63例应用开窗/支架术治疗的灌注不良综合征患者因无开放性主动脉修复而被排除。包括器官衰竭死亡（n=31），主动脉破裂死亡（n=16），并存活出院（n=16）。
■与无灌注不良综合征组相比，灌注不良综合征组有更多的急性肾功能衰竭患者(60%vs4.3%,P<.001)。两组的主动脉根和弓手术相似。术后,灌注不良综合征组的手术死亡率相似(5.2%vs7.9%,P=.35）和永久性透析（4.7%vs2.9%，P=.50），但更多的新发透析(22%对7.7%，P<.001）和长时间通气（72%vs49%，P<.001)。主动脉弓的生长速率（0.38vs0.35mm/年，P=.81）在灌注不良综合征和无灌注不良综合征组之间相似。降主动脉生长速率（1.03vs0.68mm/年，P=.001）和腹主动脉生长速率（0.76vs0.59毫米/年，P=.02）在灌注不良综合征组中明显更高。10年内再手术的累积发生率（18%vs18%，P=0.81）和15年生存结果（50％vs48％，P=.43）在灌注不良综合征和无灌注不良综合征组之间相似。
■血管内开窗/支架置入术后延迟开放主动脉修复术是血流灌注不良综合征患者的有效治疗方法。
■从1996年到2021年，927例患者出现急性A型主动脉夹层。其中,534例进行DeBakeyI型夹层，无灌注不良综合征，并接受了紧急开放主动脉修复术（无灌注不良综合征组），而97例灌注不良综合征患者接受开窗术/支架置入术和延迟开放主动脉修复术(灌注不良综合征组).63例应用开窗/支架术治疗的灌注不良综合征患者因无开放性主动脉修复而被排除。包括器官衰竭死亡（n=31），主动脉破裂死亡（n=16），并存活出院（n=16）。
■与无灌注不良综合征组相比，灌注不良综合征组有更多的急性肾功能衰竭患者(60%vs4.3%,P<.001)。两组的主动脉根和弓手术相似。术后,灌注不良综合征组的手术死亡率相似(5.2%vs7.9%,P=.35）和永久性透析（4.7%vs2.9%，P=.50），但更多的新发透析(22%对7.7%，P<.001）和长时间通气（72%vs49%，P<.001)。主动脉弓的生长速率（0.38vs0.35mm/年，P=.81）在灌注不良综合征和无灌注不良综合征组之间相似。降主动脉生长速率（1.03vs0.68mm/年，P=.001）和腹主动脉生长速率（0.76vs0.59毫米/年，P=.02）在灌注不良综合征组中明显更高。10年内再手术的累积发生率（18%vs18%，P=0.81）和15年生存结果（50％vs48％，P=.43）在灌注不良综合征和无灌注不良综合征组之间相似。
■血管内开窗/支架置入术后延迟开放主动脉修复术是血流灌注不良综合征患者的有效治疗方法。
