PDF(Pubmed)
Abstract：
OBJECTIVE: The Dissected Aorta Repair Through Stent (DARTS) Implantation trial demonstrated positive proximal aortic remodelling following aortic dissection repair with the AMDS hybrid prosthesis. In this study, we look to identify predictors of aortic remodelling following aortic dissection repair with AMDS including whether communications between branch vessels and the false lumen (FL) predict aortic growth.
METHODS: The DARTS implantation trial included patients who underwent acute DeBakey type I aortic dissection (ATAD I) repair with the AMDS from March 2017 to January 2019. Anatomic measurements were collected from original computerized tomography scans. Measurements were taken at zones 2, 3, 6 and 9. Patients were grouped based on the number of FL communications with the supra-aortic branch vessels or visceral branch vessels.
RESULTS: Forty-seven patients were included in the original DARTS implantation trial. Patients with FL communications with the supra-aortic branch vessels tended to have significant growth at zone 3 (P = 0.02-0.0018), while greater numbers of visceral FL communications tended to predict aortic growth at zones 3 (P = 0.003), 6 (P = 0.017-0.0087) and 9 (P = 0.0016-0.0003).
CONCLUSIONS: Aortic remodelling following ATAD I repair using the AMDS may be predicted by local FL communications with branch vessels. Patients undergoing ATAD I repair were more likely to experience significant aortic growth in zone 3 with more head vessel communications and in zones 3, 6 and 9 with more visceral FL communications. Predictors of aortic remodelling may help to guide initial surgical management for aortic dissection patients.
METHODS: The DARTS implantation trial included patients who underwent acute DeBakey type I aortic dissection (ATAD I) repair with the AMDS from March 2017 to January 2019. Anatomic measurements were collected from original computerized tomography scans. Measurements were taken at zones 2, 3, 6 and 9. Patients were grouped based on the number of FL communications with the supra-aortic branch vessels or visceral branch vessels.
RESULTS: Forty-seven patients were included in the original DARTS implantation trial. Patients with FL communications with the supra-aortic branch vessels tended to have significant growth at zone 3 (P = 0.02-0.0018), while greater numbers of visceral FL communications tended to predict aortic growth at zones 3 (P = 0.003), 6 (P = 0.017-0.0087) and 9 (P = 0.0016-0.0003).
CONCLUSIONS: Aortic remodelling following ATAD I repair using the AMDS may be predicted by local FL communications with branch vessels. Patients undergoing ATAD I repair were more likely to experience significant aortic growth in zone 3 with more head vessel communications and in zones 3, 6 and 9 with more visceral FL communications. Predictors of aortic remodelling may help to guide initial surgical management for aortic dissection patients.
摘要：
目的：通过支架植入术进行的主动脉夹层修复试验显示，AMDS杂交假体修复主动脉夹层后，近端主动脉重塑呈阳性。在这项研究中,我们希望确定AMDS修复主动脉夹层后主动脉重塑的预测因素,包括分支血管和假腔之间的通信是否预测主动脉生长.
方法：通过支架植入术进行的主动脉夹层修复试验包括2017年3月至2019年1月接受AMDS急性DeBakeyI型主动脉夹层修复术的患者。解剖测量是从原始计算机断层扫描中收集的。在区域2、3、6和9进行测量。根据与主动脉上分支血管或内脏分支血管的假腔通信的数量对患者进行分组。
结果：47例患者被纳入原始解剖主动脉通过支架植入修复试验。与主动脉上分支血管的假腔通信的患者倾向于在3区具有显著的生长(p=0.02-0.0018),而更多的内脏假腔通信倾向于预测3区的主动脉生长（p=0.003），6（p=0.017-0.0087），和9(p=0.0016-0.0003)。
结论：使用AMDS的急性DeBakeyI型主动脉夹层修复术后的主动脉重塑可以通过与分支血管的局部假腔通信来预测。接受急性DeBakeyI型主动脉夹层修复术的患者更有可能在头部血管通讯较多的3区以及内脏假腔通讯较多的3、6和9区经历明显的主动脉生长。主动脉重塑的预测因素可能有助于指导主动脉夹层患者的初始手术治疗。
方法：通过支架植入术进行的主动脉夹层修复试验包括2017年3月至2019年1月接受AMDS急性DeBakeyI型主动脉夹层修复术的患者。解剖测量是从原始计算机断层扫描中收集的。在区域2、3、6和9进行测量。根据与主动脉上分支血管或内脏分支血管的假腔通信的数量对患者进行分组。
结果：47例患者被纳入原始解剖主动脉通过支架植入修复试验。与主动脉上分支血管的假腔通信的患者倾向于在3区具有显著的生长(p=0.02-0.0018),而更多的内脏假腔通信倾向于预测3区的主动脉生长（p=0.003），6（p=0.017-0.0087），和9(p=0.0016-0.0003)。
结论：使用AMDS的急性DeBakeyI型主动脉夹层修复术后的主动脉重塑可以通过与分支血管的局部假腔通信来预测。接受急性DeBakeyI型主动脉夹层修复术的患者更有可能在头部血管通讯较多的3区以及内脏假腔通讯较多的3、6和9区经历明显的主动脉生长。主动脉重塑的预测因素可能有助于指导主动脉夹层患者的初始手术治疗。
