Journal of the American College of Surgeons · 2025
Simple vs Complex Aortic Arch Repair in Acute Type A Aortic Dissection.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод пока не подготовлен
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Pendarvis Jordyn, Sharaf Omar M, Bilgili Ahmet, Jiang Zhihua, Jeng Jaden A, Demos Daniel S, Spratt John R, Hess Phillip, Beaver Thomas M, Upchurch Gilbert R, Martin Tomas D, Jeng Eric I
Аннотация
BACKGROUND: The purpose of this study was to evaluate the clinical outcomes of patients undergoing a simpler (hemiarch) vs complex (zone 2 arch) aortic repair for acute type A aortic dissection (TAAD).
STUDY DESIGN: Adults (18 years or older) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as a modified Rankin scale of 4 or greater. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.
RESULTS: Two hundred eighty-three patients with acute TAAD underwent hemiarch (44.5%, n = 126) and/or zone 2 arch (55.5%, n = 157) repair. Hemiarch patients were older (63.3 ± 14.1 vs 56.3 ± 12.2 years, p < 0.001), but had lower rates of preoperative cerebrovascular disease (11.1% [n = 14] vs 21.7% [n = 34], p = 0.03), chronic kidney disease (16.7% [n = 21] vs 33.1% [n = 52], p = 0.003), and previous sternotomy (13.5% [n = 17] vs 35.0% [n = 55], p < 0.001). Cardiopulmonary bypass and cross-clamp times were shorter in hemiarch patients (214 ± 78.5 vs 261 ± 62.3 minutes, p < 0.001; 135 ± 54.4 vs 182 ± 60.0 minutes, p < 0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5% [n = 13], p = 0.12), tracheostomy (14.8% [n = 43], p = 0.15), pneumonia (17.2% [n = 50], p = 0.24), or renal failure requiring permanent dialysis (6.2% [n = 18], p = 0.47). In multivariable analysis, older age (hazard ratio 1.05, 95% CI 1.02 to 1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer an increased risk (hazard ratio 0.68, 95% CI 0.35 to 1.31).
CONCLUSIONS: Complex aortic arch reconstruction provides a framework for downstream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.
STUDY DESIGN: Adults (18 years or older) who underwent hemiarch or zone 2 arch repair for acute, hyperacute, or acute on chronic TAAD at a single institution between January 2018 and April 2024 were reviewed. Disabling stroke was defined as a modified Rankin scale of 4 or greater. Statistical analysis included univariate comparisons, Kaplan-Meier analysis, and multivariable modeling.
RESULTS: Two hundred eighty-three patients with acute TAAD underwent hemiarch (44.5%, n = 126) and/or zone 2 arch (55.5%, n = 157) repair. Hemiarch patients were older (63.3 ± 14.1 vs 56.3 ± 12.2 years, p < 0.001), but had lower rates of preoperative cerebrovascular disease (11.1% [n = 14] vs 21.7% [n = 34], p = 0.03), chronic kidney disease (16.7% [n = 21] vs 33.1% [n = 52], p = 0.003), and previous sternotomy (13.5% [n = 17] vs 35.0% [n = 55], p < 0.001). Cardiopulmonary bypass and cross-clamp times were shorter in hemiarch patients (214 ± 78.5 vs 261 ± 62.3 minutes, p < 0.001; 135 ± 54.4 vs 182 ± 60.0 minutes, p < 0.001, respectively). Postoperatively, there was no difference in the rate of disabling stroke (4.5% [n = 13], p = 0.12), tracheostomy (14.8% [n = 43], p = 0.15), pneumonia (17.2% [n = 50], p = 0.24), or renal failure requiring permanent dialysis (6.2% [n = 18], p = 0.47). In multivariable analysis, older age (hazard ratio 1.05, 95% CI 1.02 to 1.08) was a risk factor for longitudinal mortality, while complex aortic arch repair did not confer an increased risk (hazard ratio 0.68, 95% CI 0.35 to 1.31).
CONCLUSIONS: Complex aortic arch reconstruction provides a framework for downstream endovascular procedures for the remaining aorta and can be performed in acute TAAD without increased risk of morbidity or mortality compared with a simpler repair.