背景:目前国内开腹主动脉修复术治疗胸降动脉瘤(DTAA)和胸腹主动脉瘤(TAAA)的结果尚不清楚。我们使用胸外科医师协会成人心脏外科数据库(STS-ACSD)对此进行了评估。
方法:从2017年7月1日至2022年6月30日,我们确定了3522名成年人正在进行计划的DTAA修复(开放式328,血管内1895)或TAAA修复(开放式870,血管内429),在排除升主动脉或主动脉弓动脉瘤(区域0、1或2)后,在0区或1区的近端范围的干预,肾近/肾下主动脉干预,混合程序,主动脉创伤,和主动脉感染。
结果:大多数DTAA干预措施(85.2%)是血管内修复,而大多数TAAA干预措施是开放式维修(66.9%)。对于DTAA,手术死亡率,永久中风率,脊髓损伤率为4.2%,3.8%,血管内修复术为2.4%和9.2%,8.5%,开放式维修为4.6%,分别(均p<0.05)。对于TAAA,手术死亡率,永久中风率,脊髓损伤率为6.5%,2.1%,血管内修复率为3.0%,11.7%,6.0%,开放修复为12.2%(所有p<0.05)。每年开放的TAAA修复量的增加与较低的手术死亡率相关。永久性中风,或者脊髓损伤。
结论:基于STS-ACSD数据,血管内修复是治疗DTAA的主要方法,而大多数接受TAAA干预的患者接受了开放性手术修复.开放和血管内方法之间的结果差异可能与患者选择有关。通过开放式TAAA修复增加中心的经验与改善的结果相关。
BACKGROUND: Contemporary national outcomes of open and endovascular aortic repair for descending thoracic (DTAA) and thoracoabdominal aortic aneurysms (TAAA) are unclear. We evaluated this using the Society of Thoracic Surgeons Adult Cardiac Surgery Database (STS-ACSD).
METHODS: From 07/01/2017 to 6/30/2022, we identified 3522 adults undergoing planned DTAA repair (open 328, endovascular 1895) or TAAA repair (open 870, endovascular 429), after excluding ascending aorta or aortic arch aneurysms (zone 0, 1, or 2), interventions with a proximal extent in zone 0 or zone 1, juxtarenal/infrarenal aortic interventions, hybrid procedures, aortic trauma, and aortic infection.
RESULTS: Most DTAA interventions (85.2%) were endovascular repairs, while most TAAA interventions were open repairs (66.9%). For DTAA, the operative mortality, permanent stroke rate, and rate of spinal cord injury were 4.2%, 3.8%, and 2.4% for endovascular repair and 9.2%, 8.5%, and 4.6% for open repair, respectively (all p<0.05). For TAAA, the operative mortality, permanent stroke rate, and rate of spinal cord injury were 6.5%, 2.1%, and 3.0% for endovascular repair and 11.7%, 6.0%, and 12.2% for open repair (all p<0.05). Increasing annual open TAAA repair volume was associated with lower odds of experiencing the composite of operative mortality, permanent stroke, or spinal cord injury.
CONCLUSIONS: Based on STS-ACSD data, endovascular repair was the predominant approach for treating DTAA, while most patients undergoing TAAA interventions had an open surgical repair. Outcome differences between open and endovascular approaches may be related to patient selection. Increasing center experience with open TAAA repair is associated with improved outcomes.