Abstract：
BACKGROUND: Surgery for Stanford type A aortic dissection (TAAD) is associated with an increased risk of late aortic reoperations due to degeneration of the dissected aorta.
METHODS: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments.
RESULTS: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060).
CONCLUSIONS: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04831073.
METHODS: The subjects of this analysis were 990 TAAD patients who survived surgery for acute TAAD and had complete data on the diameter and dissection status of all aortic segments.
RESULTS: After a mean follow-up of 4.2 ± 3.6 years, 60 patients underwent 85 distal aortic reoperations. Ten-year cumulative incidence of distal aortic reoperation was 9.6%. Multivariable competing risk analysis showed that the maximum preoperative diameter of the abdominal aorta (SHR 1.041, 95%CI 1.008-1.075), abdominal aorta dissection (SHR 2.133, 95%CI 1.156-3.937) and genetic syndromes (SHR 2.840, 95%CI 1.001-8.060) were independent predictors of distal aortic reoperation. Patients with a maximum diameter of the abdominal aorta >30 mm and/or abdominal aortic dissection had a cumulative incidence of 10-year distal aortic reoperation of 12.0% compared to 5.7% in those without these risk factors (adjusted SHR 2.076, 95%CI 1.062-4.060).
CONCLUSIONS: TAAD patients with genetic syndromes, and increased size and dissection of the abdominal aorta have an increased the risk of distal aortic reoperations. A policy of extensive surgical or hybrid primary aortic repair, completion endovascular procedures for aortic remodeling and tight surveillance may be justified in these patients.
BACKGROUND: ClinicalTrials.gov Identifier: NCT04831073.
摘要：
背景：StanfordA型主动脉夹层（TAAD）的手术与由于夹层主动脉变性而导致的晚期主动脉再手术风险增加相关。
方法：本分析的对象是990例TAAD患者，这些患者在急性TAAD手术中存活，并且具有关于所有主动脉节段的直径和夹层状态的完整数据。
结果：经过4.2±3.6年的平均随访，60例患者接受85次远端主动脉再手术。远端主动脉再手术的十年累积发生率为9.6％。多变量竞争风险分析表明，腹主动脉的最大术前直径（SHR1.041，95CI1.008-1.075），腹主动脉夹层(SHR2.132,95CI1.156-3.937)和遗传综合征(SHR2.840,95CI1.001-8.060)是远端主动脉再手术的独立预测因子.腹主动脉最大直径>30mm和/或腹主动脉夹层的患者10年远端主动脉再手术的累积发生率为12.0%，而没有这些危险因素的患者为5.7%(调整SHR2.076,95CI1.062-4.060)。
结论：患有遗传综合征的TAAD患者，腹主动脉的大小和夹层增加增加了远端主动脉再次手术的风险。广泛手术或混合原发性主动脉修复的政策，在这些患者中,完成主动脉重塑的腔内手术和严密监测可能是合理的.
背景：ClinicalTrials.gov标识符：NCT04831073。
方法：本分析的对象是990例TAAD患者，这些患者在急性TAAD手术中存活，并且具有关于所有主动脉节段的直径和夹层状态的完整数据。
结果：经过4.2±3.6年的平均随访，60例患者接受85次远端主动脉再手术。远端主动脉再手术的十年累积发生率为9.6％。多变量竞争风险分析表明，腹主动脉的最大术前直径（SHR1.041，95CI1.008-1.075），腹主动脉夹层(SHR2.132,95CI1.156-3.937)和遗传综合征(SHR2.840,95CI1.001-8.060)是远端主动脉再手术的独立预测因子.腹主动脉最大直径>30mm和/或腹主动脉夹层的患者10年远端主动脉再手术的累积发生率为12.0%，而没有这些危险因素的患者为5.7%(调整SHR2.076,95CI1.062-4.060)。
结论：患有遗传综合征的TAAD患者，腹主动脉的大小和夹层增加增加了远端主动脉再次手术的风险。广泛手术或混合原发性主动脉修复的政策，在这些患者中,完成主动脉重塑的腔内手术和严密监测可能是合理的.
背景：ClinicalTrials.gov标识符：NCT04831073。
