马琼
中国医学科学院阜外医院 普外科
Background:To compare outcomes between sinus replacement (SR) and conservative repair (CR) for dissected roots with normal size.Methods:From October 2018 to April 2021, a prospective cohort study was carried out. Patients were assigned to two groups (SR group and CR group) according to whether they underwent sinus replacement. Propensity score matching was applied to adjust preoperative variables and Kaplan-Meier method was used for survival analysis.Results:Three hundred and eighty-seven patients were enrolled. In the whole cohort, 18 patients (4.7%) died postoperatively. The operative mortality of SR group was comparable to CR group (3.2% vs. 6.0%, p = 0.192 before matching; 3.5% vs. 7.0%, p = 0.267 after matching) and the incidence of hemostasis management under restarted cardiopulmonary bypass for root bleeding was lower in SR group (1.6% vs. 7.0%, p = 0.002 before matching; 2.1% vs. 8.5%, p = 0.03 after matching). The median follow-up duration was 12 months. There were 3 reoperations in the CR group. The estimated cumulative event rate of reoperation was 1.1 % at 12 months and 1.6% at 24 months in CR group, with a trend of a lower rate in the SR group (log-rank p = 0.089 before matching, p = 0.075 after matching). There was one late death in each group. The estimated cumulative event rate of death was 3.8% at 12 months and 24 months in the SR group, and was 6.6% in the CR group with no significant difference (log-rank p = 0.218 before matching, p = 0.120 after matching). Aortic regurgitation significantly improved postoperatively and remained stable during follow-up.Conclusions:Sinus replacement is a simple, safe, and effective technique for repairing severely dissected sinus with a comparable time spent in operation and excellent immediate and short-term results. It had the advantages of eliminating false lumen and avoiding aortic root bleeding.
Frontiers in cardiovascular medicine 2022
Background:The optimal arterial cannulation site for acute aortic dissection repair is unclear, especially for complex arch surgery. Axillary artery cannulation is widely accepted but adding femoral artery cannulation to it was considered to potentially improve perfusion and early outcomes. To clarify this point, a comparison of perioperative outcomes for these two different cannulation strategies was conducted regarding the pathological features of dissection.Methods:From January 2010 to December 2019, 927 consecutive patients underwent a total arch replacement combined with frozen elephant trunk for acute type A aortic dissection. The data, including detailed pathological features, were retrospectively collected and analyzed. Propensity score matching and multivariate logistic regression analysis were used for adjusting confounders that are potentially related to the outcome.Results:A total of 523 patients (56.3%) accepted a dual arterial cannulation (DAC group), and 406 patients (43.7%) received a single axillary artery cannulation (SAC group). In total, 388 pairs of patients were well-matched. Whether before or after adjusting the preoperative characteristics by matching, there were no significant differences in operative mortality (6.7 vs. 5.4%, P = 0.420 before matching; 5.4 vs. 5.4%, P = 1 after matching), stroke (6.7 vs. 5.4%, P = 0.420 before matching; 6.4 vs. 5.2%, P = 0.435 after matching), spinal cord injury (5 vs. 5.7%, P = 0.640 before matching; 5.4 vs. 5.7%, P = 1. After matching), and acute renal failure requiring dialysis (13.8 vs. 9.6%, P =0.050 before matching; 12.6 vs. 9.5%, P = 0.174) between the two groups. Dual arterial cannulation was not an independent protective factor of operative mortality (odds ratio [OR] 1.01, 95% confidence interval [CI] 0.55-1.86), stroke (OR 1.17, 95% CI 0.65-2.11), spinal cord injury (OR 1.17, 95% CI 0.65-2.11), and acute renal failure requiring continuous renal replacement therapy (CRRT) (OR 1.24, 95% CI 0.78-1.97) after adjusting for confounding factors by multivariable logistic regression analysis. In the subgroup analysis, no advantage of dual arterial cannulation was found for a particular population.Conclusions:Single axillary artery cannulation was competent in the complex arch repair for acute aortic dissection, presenting with a satisfactory result as dual arterial cannulation. Adding femoral artery cannulation was necessary when a sufficient flow volume could not be achieved by axillary artery cannulation or when a lower limb malperfusion existed.
Frontiers in cardiovascular medicine 2022
Objective To evaluate the early and mid-term results after surgical repair of thoracoabdominal aortic aneurysm(TAAA)in patients with DeBakey typeⅠor Ⅲ aortic dissection. Methods The clinical data of 130 patients who underwent TAAA repair for chronic DeBakey typeⅠ(groupⅠ, n=47)or type Ⅲ(group Ⅲ, n=83)aortic dissections in our center between January 2009 and December 2017 were retrospectively analyzed.Early postoperative results,midterm survival,and re-interventions were compared between these two groups. Results The 30-day mortality rate was 6.9%(n=9)in the overall cohort,with no statistic difference between groupⅠand group Ⅲ(10.6% vs. 4.8%;χ2=0.803, P=0.370).The incidence of major adverse events(38.3% vs. 51.8%;χ2=2.199, P=0.138),5-year actuarial survival rate [(81.7±5.9)% vs.(87.2±4.2)%;χ2=0.483, P=0.487],and 5-year actuarial freedom from all reinterventions [(84.5±6.7)% vs.(85.5±4.8)%;χ2=0.010, P=0.920] showed no significant differences between these two groups. Conclusions The early and mid-term outcomes after surgical repair of TAAA are similar for DeBakey typeⅠ and type Ⅲ patients.However,studies with larger sample sizes are still required.
Zhongguo yi xue ke xue yuan xue bao. Acta Academiae Medicinae Sinicae 2020
