METHODS: Between January 1996 and December 2022, 120 patients underwent aortic arch reoperations after primary proximal aortic surgery. We retrospectively analysed perioperative data, as well as early and mid-term outcomes in these patients.
RESULTS: Indications for arch reintervention included new aortic aneurysm in 34 patients (28.3%), expanding post-dissection aneurysm in 36 (30.0%), aortic graft infection in 39 (32.5%) and new aortic dissection in 9 cases. Two patients underwent reoperation due to iatrogenic complications. Thirty-one patients (25.8%) had concomitant endocarditis. In-hospital and 30-day mortality rates were 11.7% and 15.0%, respectively. Stroke was observed in 11 (9.2%) and paraplegia in 1 patient. Prior surgery due to aneurysm [odds ratio 4.5; 95% confidence interval (CI) 1.4-17.3] and critical preoperative state (odds ratio 5.9; 95% CI 1.5-23.7) were independent predictors of 30-day mortality. Overall 1- and 5-year survival was 65.8 ± 8.8% and 51.2 ± 10.6%, respectively. Diabetes mellitus (hazard ratio 2.4; 95% CI 1.0-5.1) and peripheral arterial disease (hazard ratio 4.7; 95% CI 1.1-14.3) were independent predictors of late death. The cumulative incidence of reoperations was 12.6% (95% CI 6.7-20.4%) at 5 years. Accounting for mortality as a competing event, connective tissue disorders (subdistribution hazard ratio 4.5; 95% CI 1.6-15.7) and interval between primary and redo surgery (subdistribution hazard ratio 1.04; 95% CI 1.02-1.06) were independent predictors of reoperations after redo arch surgery.
CONCLUSIONS: Despite being technically demanding, aortic arch reoperations are feasible and can be performed with acceptable results.
方法:在1996年1月至2022年12月之间,120例患者在原发性近端主动脉手术后接受了主动脉弓再次手术。我们回顾性分析围手术期资料,以及这些患者的早期和中期结局。
结果:弓部再介入的适应症包括34例患者(28.3%)的新发主动脉瘤,36例(30.0%)扩大的夹层后动脉瘤,主动脉移植物感染39例(32.5%),新发主动脉夹层9例。由于医源性并发症,两名患者接受了再次手术。31例患者(25.8%)合并心内膜炎。住院和30天死亡率分别为11.7%和15.0%,分别。11例(9.2%)患者出现中风,1例患者出现截瘫。术前动脉瘤(OR4.5;95%CI1.4-17.3)和术前危重状态(OR5.9;95%CI1.5-23.7)是30天死亡率的独立预测因子。1年和5年总生存率为65.8±8.8%,和51.2±10.6%。糖尿病(HR2.4;95%CI1.0-5.1)和外周动脉疾病(HR4.7;95%CI1.1-14.3)是晚期死亡的独立预测因子。5年再次手术的累积发生率为12.6%(95%CI6.7-20.4%)。将死亡率视为竞争事件,结缔组织疾病(SHR4.5;95%CI1.6-15.7)和初次手术与重做手术间隔时间(SHR1.04;95%CI1.02-1.06)是重做足弓手术后再次手术的独立预测因子。
结论:尽管技术要求很高,主动脉弓再次手术是可行的,并且可以获得可接受的结果。