American journal of surgery · 2025
Perioperative and long-term outcomes of surgical treatment for penetrating aortic ulcer in the aortic arch: A retrospective cohort analysis.
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Wang Luchen, Liu Yanxiang, Zhang Bowen, Zhou Sangyu, Zhao Ruojin, Xie Mingxin, Chen Xuyang, Gu Haoyu, Yu Cuntao, Dun Yaojun, Sun Xiaogang
Аннотация
OBJECTIVE: This study was designed to evaluate the perioperative and long-term outcomes of surgical treatment, including open and hybrid repairs, for patients with penetrating aortic ulcer (PAU) in the aortic arch.
METHODS: A single-center retrospective analysis from China was conducted on 72 patients with PAU in the aortic arch who underwent surgical treatment including open and hybrid repairs between January 2010 and December 2022. The study included 10 patients in the urgent repair group and 62 patients in the elective repair group. The primary endpoints included major adverse events and long-term survival. Major adverse events included in-hospital mortality, reoperation for bleeding, stroke, paraplegia, and acute renal failure.
RESULTS: The rate of major adverse events was 13.9 % (10/72), with an in-hospital mortality rate of 2.8 % (2/72). The mean follow-up period was 69 months. The overall survival rates at 1, 5, and 7 years after surgery were 95.8 %, 91.8 %, and 86.0 %, respectively. Subgroup and regression analyses showed that urgent repair was not significantly associated with the occurrence of major adverse events and long-term survival. Age (OR: 1.12, 95 % CI: 1.00-1.26; P = 0.042) and diabetes (OR: 5.98, 95 % CI: 1.01-35.32; P = 0.048) were found to be independent risk factors for major adverse events as well as NYHA grade ≥ III (HR: 14.68, 95 % CI: 2.11-102.10; P = 0.007) and diabetes (HR: 5.39, 95 % CI: 1.10-26.37; P = 0.038) proved to be independent risk factors for overall survival. Compared to the elective repair group, patients who underwent urgent repair had larger PAUs (P = 0.052), more frequent localization in Zone 0 or Zone 1 (P = 0.038), and were more likely to undergo open surgery, particularly total arch replacement with frozen elephant trunk (P = 0.001). They also experienced longer cardiopulmonary bypass time (P = 0.004), lower minimum temperature (P = 0.001), and lower total expenditure (P < 0.001).
CONCLUSIONS: The surgical management of PAU in the aortic arch using open or hybrid repair techniques appears to be feasible, with favorable perioperative and long-term outcomes. However, heightened vigilance may be required for elderly patients, diabetic patients, and those with cardiac insufficiency.
METHODS: A single-center retrospective analysis from China was conducted on 72 patients with PAU in the aortic arch who underwent surgical treatment including open and hybrid repairs between January 2010 and December 2022. The study included 10 patients in the urgent repair group and 62 patients in the elective repair group. The primary endpoints included major adverse events and long-term survival. Major adverse events included in-hospital mortality, reoperation for bleeding, stroke, paraplegia, and acute renal failure.
RESULTS: The rate of major adverse events was 13.9 % (10/72), with an in-hospital mortality rate of 2.8 % (2/72). The mean follow-up period was 69 months. The overall survival rates at 1, 5, and 7 years after surgery were 95.8 %, 91.8 %, and 86.0 %, respectively. Subgroup and regression analyses showed that urgent repair was not significantly associated with the occurrence of major adverse events and long-term survival. Age (OR: 1.12, 95 % CI: 1.00-1.26; P = 0.042) and diabetes (OR: 5.98, 95 % CI: 1.01-35.32; P = 0.048) were found to be independent risk factors for major adverse events as well as NYHA grade ≥ III (HR: 14.68, 95 % CI: 2.11-102.10; P = 0.007) and diabetes (HR: 5.39, 95 % CI: 1.10-26.37; P = 0.038) proved to be independent risk factors for overall survival. Compared to the elective repair group, patients who underwent urgent repair had larger PAUs (P = 0.052), more frequent localization in Zone 0 or Zone 1 (P = 0.038), and were more likely to undergo open surgery, particularly total arch replacement with frozen elephant trunk (P = 0.001). They also experienced longer cardiopulmonary bypass time (P = 0.004), lower minimum temperature (P = 0.001), and lower total expenditure (P < 0.001).
CONCLUSIONS: The surgical management of PAU in the aortic arch using open or hybrid repair techniques appears to be feasible, with favorable perioperative and long-term outcomes. However, heightened vigilance may be required for elderly patients, diabetic patients, and those with cardiac insufficiency.