背景:近端或远端主动脉扩张的进展被定义为急性A型主动脉夹层(ATAAD)手术后逆转的主动脉重塑,这可能取决于主动脉壁退化。
方法:我们研究了主动脉壁退化是否与ATAAD手术后导致主动脉再手术的逆向主动脉重构相关。总之,对141名在坦佩雷接受ATAAD手术的连续患者进行了评估。手术切除的升主动脉壁经42例退行性处理,动脉粥样硬化和炎性组织学变量。在平均4.9年的随访期间,将接受主动脉再手术(Redos)的患者与未接受主动脉再手术(对照组)的患者进行了比较。
结果:Redos比对照组年轻(56岁和66岁,分别,P<0.001),并且在ATAAD之前进行心脏手术的频率较低。最初的手术包括大多数升主动脉的置换。随访期间有21例患者死亡,而对照组中有51例患者死亡(logRankP=0.002)。主动脉壁的组织学显示增加的弹性纤维碎片,损失,与对照组相比,Redos中的混乱(2.1±0.5vs.1.9±0.5,分数单位(PSU),P=0.043和1.7±0.8vs.1.2±0.8,PSU,分别为P=0.016)。中度动脉粥样硬化在Redos与对照(9.5%与33%,PSU,分别为P=0.037)。
结论:根据这项探索性研究,组织病理学显示ATAAD期间主动脉壁明显变性。ATAAD后逆转主动脉重构与升主动脉壁弹性纤维断裂的存在有关,ATAAD期间的损失和混乱。
BACKGROUND: Progression of proximal or distal aortic dilatation is defined as reverse aortic remodeling after surgery for acute type A aortic dissection (ATAAD) that may be dependent on aortic wall degeneration.
METHODS: We investigated whether aortic wall degeneration is associated with reverse aortic remodeling leading to aortic reoperation after surgery for ATAAD. Altogether, 141 consecutive patients undergoing surgery for ATAAD at Tampere were evaluated. The resected ascending aortic wall at surgery was processed for 42 degenerative, atherosclerotic and inflammatory histological variables. Patients undergoing aortic reoperations (Redos) were compared with those without aortic reoperations (Controls) during a mean 4.9-year follow-up.
RESULTS: Redos were younger than Controls (56 and 66 years, respectively, P < 0.001), and had less frequently previous cardiac surgery prior to ATAAD. Initial surgery encompassed replacement of the ascending aorta in the majority. There were 21 Redos in which one patient died during follow-up as compared with 51 deaths in Controls (log Rank P = 0.002). Histology of the aortic wall revealed increased elastic fiber fragmentation, loss, and disorganization in Redos as compared with Controls (2.1 ± 0.5 vs. 1.9 ± 0.5, Point score unit (PSU), P = 0.043 and 1.7 ± 0.8 vs. 1.2 ± 0.8, PSU, P = 0.016, respectively). Moderate atherosclerosis occurred less often in Redos vs. Controls (9.5% vs. 33%, PSU, P = 0.037, respectively).
CONCLUSIONS: According to this exploratory study, histopathology reveals distinctive aortic wall degeneration during ATAAD. Reverse aortic remodeling after ATAAD is associated with the presence of ascending aortic wall elastic fiber fragmentation, loss and disorganization during ATAAD.