■在全弓置换中重新植入主动脉上血管的2种最可接受的技术包括分支移植技术(脱支)或整体技术(岛)。我们的目标是回顾我们在全足弓置换方面的经验,并报告专门用于胸主动脉手术的高容量中心的短期和长期结果。
■查询主动脉手术数据库,以确定在1997年至2022年期间接受全弓置换的所有连续患者。426例接受全足弓置换的患者中,303(71%)接受了岛技术,123(29%)接受了脱支方法。使用多变量模型比较手术和长期结果。
■脱支组年龄较小(64±14岁vs69±12岁,P=.001),以前经历过更多的心脏手术(54.5%vs27.4%,P<.001),并有更多的结缔组织疾病(20.3%vs4.6%,P<.001)。脱支方法与更长的总循环停止时间相关(47±15分钟vs37±10分钟,P<.001)和心脏缺血时间(116±41分钟vs100±37分钟,P<.001)。脱支组术中或术后接受血液制品治疗的患者较多(56.1%vs42.9%,P=.018)。所有其他早期结果在组间没有差异。手术总死亡率为1.4%(2.4%vs1%,P=0.486);术后主要并发症的发生率为6.3%(5.7%vs6.6%,P=.897)。十年生存率为80%(78%vs80.9%,对数秩P=.356)。多变量Cox回归分析表明,两种手术方式都与生存优势(风险比,1.18;0.73-1.89;P=.495)。
■去分支需要更长的操作时间,具有相似的早期和长期结果。术前合并症,不是手术技术,预测主要不良事件和长期生存。
UNASSIGNED: The 2 most acceptable techniques for reimplantation of the supra-aortic vessels in total arch replacement include the branched graft technique (debranching) or en bloc technique (island). We aim to review our experience with total arch replacement and report short- and long-term outcomes from a high-volume center dedicated to surgery for the thoracic aorta.
UNASSIGNED: The aortic surgery database was queried to identify all consecutive patients undergoing total arch replacement between 1997 and 2022. Of the 426 patients who underwent total arch replacement, 303 (71%) received the island technique and 123 (29%) received the debranching approach. Operative and long-term outcomes were compared using multivariable models.
UNASSIGNED: The debranching group was younger (64 ± 14 years vs 69 ± 12 years, P = .001), had undergone more previous cardiac operations (54.5% vs 27.4%, P < .001), and had more connective tissue disorder (20.3% vs 4.6%, P < .001). The debranching approach was associated with longer total circulatory arrest time (47 ± 15 minutes vs 37 ± 10 minutes, P < .001) and cardiac ischemic time (116 ± 41 minutes vs 100 ± 37 minutes, P < .001). More patients in the debranching group received blood products intraoperatively or postoperatively (56.1% vs 42.9%, P = .018). All other early outcomes did not differ between groups. Overall operative mortality was 1.4% (2.4% vs 1%, P = .486); the incidence of major postoperative complications was 6.3% (5.7% vs 6.6%, P = .897). Ten-year survival was 80% (78% vs 80.9%, log-rank P = .356). Multivariable Cox regression analysis demonstrated that neither surgical approach was associated with survival advantage (hazard ratio, 1.18; 0.73-1.89; P = .495).
UNASSIGNED: Debranching requires a longer operative time, with similar early and long-term outcomes. Preoperative comorbidity, not surgical technique, predicts major adverse events and long-term survival.