- 作者：Angelo M. Dell'Aquila ; Giovanni Concistr猫 ; Alina Gallo ; Stefano Pansini ; Aless ; ro Piccardo ; Giancarlo Passerone ; Tommaso Regesta
- 关键词：AAD ; acute type A aortic dissection ; DHCA ; deep hypothermic circulatory arrest ; RR ; relative risk
- 刊名：The Journal of Thoracic and Cardiovascular Surgery
- 出版年：December, 2013
- 年：2013
- 卷：146
- 期：6
- 页码：1456-1460
- 全文大小：281 K
Objective
The objective of this study was to examine the fate of the native aortic root after replacement of the ascending aorta to treat acute type A aortic dissection.Methods
Between June 1985 and January 2010, 319 consecutive patients (mean age, 63 卤 11 years) with acute type A aortic dissection underwent replacement of the ascending aorta with preservation of the aortic root. The aortic valve was also replaced in 21 of these patients (7%). The intervention was extended to the aortic arch in 210 patients (66%), of whom 173 (54%) underwent hemiarch replacement, and 37 (12%), total arch replacement.
Results
There were 109 (34%) in-hospital deaths. Of the 210 discharged patients, survival was 95%, 58%, and 27% at 1, 10, and 23 years, respectively. Freedom from reoperation on the proximal aorta was reported by 97%, 92%, and 82% patients at 5, 10, and 23 years, respectively. Twelve patients were reoperated for aortic root dilatation and 2 died during reoperation. Univariate and multivariate Cox regression analyses revealed that significant risk factors for proximal reoperation were age <60 years (P聽=聽.005; relative risk, 1.94) and Marfan syndrome (P聽=聽.011; relative risk, 2.76). At follow-up, 15 patients (11%) had an aortic root diameter of >45 mm, but they were not reoperated.
Conclusions
For acute type A aortic dissection, replacement of the ascending aorta with root preservation shows long-term effectiveness with low reoperation and aortic root dilatation rates.