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首页> 外文期刊>Therapeutic advances in cardiovascular disease. >Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection
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Impact of ascending aortic, hemiarch and arch repair on early and long-term outcomes in patients with Stanford A acute aortic dissection

机译：斯坦福大学A级急性主动脉夹层患者升主动脉，半主动脉和足弓修复对早期和长期预后的影响

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Stanford A acute aortic dissection (AAD) is a life-threatening emergency associated with major morbidity and mortality. The aim of this study was to compare outcomes of three different surgical approaches in patients with Stanford A AAD. From January 2006 to March 2015 a total of 240 consecutive patients with diagnosed Stanford A AAD underwent elective, isolated surgical aortic repair in our centre. Patients were divided into three groups according to the extent of surgical repair: isolated replacement of the ascending aorta, hemiarch replacement and total arch replacement. Patients were followed up for up to 9?years. After univariate analysis multinomial logistic regression was performed for subgroup analysis. Baseline characteristics and endpoints as well as long-term survival were analysed. There were no statistically significant differences among the three groups in terms of demographics and preoperative baseline and clinical characteristics. Incidence of in-hospital stroke (p = 0.034), need for reopening due to bleeding (p = 0.031) and in-hospital mortality (p = 0.017) increased significantly with the extent of the surgical approach. There was no statistical difference in terms of long-term survival (p = 0.166) among the three groups. Applying multinomial logistic regression for subgroup analysis significantly higher odds for stroke (p = 0.023), reopening for bleeding (p = 0.010) and in-hospital mortality (p = 0.009) for the arch surgery group in comparison to the ascending aorta surgery group as well as significantly higher odds for stroke (p = 0.029) for the total arch surgery group in comparison to the hemiarch surgery group were identified. With Stanford A AAD the incidence of perioperative complications increased significantly with the extent of the surgical approach. Subgroup analysis and long-term follow up in patients undergoing isolated ascending or hemiarch surgery showed a lower incidence of cerebrovascular events compared with surgery for total arch replacement.
机译：斯坦福大学（Stanford）急性主动脉夹层（AAD）是威胁生命的紧急事件，与主要的发病率和死亡率有关。这项研究的目的是比较三种不同手术方法对斯坦福A AAD患者的疗效。从2006年1月至2015年3月，我们中心共对240例诊断为Stanford A AAD的连续患者进行了选择性，孤立的主动脉修复手术。根据手术修复的程度将患者分为三组：升主动脉的单独置换，半主动脉置换和全弓置换。对患者进行了长达9年的随访。单变量分析后，进行多项式逻辑回归进行亚组分析。分析了基线特征和终点以及长期生存。在人口统计学，术前基线和临床特征方面，三组之间无统计学差异。院内卒中的发生率（p = 0.034），因出血需要重新开放的发生率（p = 0.031）和院内死亡率（p = 0.017）随手术方法的范围而显着增加。三组之间在长期生存方面无统计学差异（p = 0.166）。与升主动脉手术组相比，应用拱门手术组的多项逻辑回归分析显着提高了中风发生几率（p = 0.023），再次开放出血（p = 0.010）和院内死亡率（p = 0.009）。与半弓形外科手术组相比，总弓形外科手术组的卒中几率显着更高（p = 0.029）。使用Stanford A AAD时，围手术期并发症的发生率随着手术方法的范围而显着增加。与单独进行全弓置换术相比，进行单独的升序或半弓手术的患者的亚组分析和长期随访显示，脑血管事件的发生率较低。

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