背景:主动脉弓置换(TAR)结合冷冻象鼻(FET)技术是先前心血管手术后的高风险手术。该研究的目的是回顾我们在该队列中的策略和结果。
方法:回顾了2010年1月至2020年12月在既往心血管手术后接受TAR联合FET的患者的数据。将患者分为选择性组和非选择性组。
结果:63名符合条件的患者分为选择性(n=44)和非选择性(n=19)组。非择期组两次手术间隔时间短于择期组(P=0.001)。两组再次手术指征不同(P=0.000),然而,再操作的类型没有区别。择期组体外循环时间短于非择期组(P=0.000)。总的30天死亡率为17.5%,非选择性组较高(P=0.013)。非择期组24h引流量增加(P=0.001),再次出血率增加(P=0.022)。非择期组术后住院时间延长(P=0.002)。然而,无进一步主动脉事件的生存率在择期组为72.3±7.1%,非选修组5年时72.9±13.5%,分别(P=0。955).
结论:在择期组中观察到30天死亡率降低和术后住院时间缩短,然而,没有再干预的长期生存率没有受到影响.
BACKGROUND: Aortic arch replacement(TAR) combined with frozen elephant trunk (FET) technique is a high-risk operation after previous cardiovascular surgery. The aim of the study was to review our strategy and outcomes in this cohort.
METHODS: Data were reviewed for patients who underwent TAR combined with FET after previous cardiovascular surgery from January 2010 to December 2020. The patients were divided into elective group and non-selective group.
RESULTS: 63 eligible patients were divided into elective(n = 44) and non-elective(n = 19) groups. The interval between two operations was shorter in non-elective group than elective groups (P = 0.001). The indication for reoperation was different in two groups (P = 0.000), however, the type of reoperations has no differences. Cardiopulmonary bypass time was shorter in elective group than non-elective group (P = 0.000). The over-all 30-day mortality rate was 17.5%, and it was higher in non-elective group (P = 0.013). The 24h drainage increased in non-elective group (P = 0.001) as well as re-explore rate for bleeding (P = 0.022). Postoperative hospital stay prolonged in non-elective group (P = 0.002). However, rates of survival without further aortic events were 72.3 ± 7.1% in elective group, 72.9 ± 13.5% in non-elective group at 5 years, respectively (P = 0. 955).
CONCLUSIONS: Reduced 30-day mortality and shortened post-operative hospital stay was observed in elective group, however, long-term survival rate without reintervention were not affected.