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首页> 外文期刊>Journal of cardiac surgery. >Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results
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Aortic root remodeling with external annuloplasty for acute type A aortic dissection: Midterm results

机译：用于急性型灌注术的主动脉根重塑A主动脉解剖：中期结果

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Background To evaluate the role of aortic root remodeling with external aortic annuloplasty (ARREAA) in acute type A aortic dissection (AAAD). Methods From May 2011 to May 2020, 59 patients out of 240 with AAAD underwent ARREAA. Data were retrospectively collected and analyzed. Results The mean age was 61.4 +/- 8.6 years and 43 patients were males (73%). Hemiarch and total arch replacement were performed in 37 (62.7%) and 14 (23.7%) patients. An aortic valvuloplasty was performed in seven patients (11.8%). Five patients (8.5%) required coronary artery bypass graft. Re-exploration for bleeding was required in six patients (10.1%). The 30-day mortality rate was 18.6%. Preoperative hemodynamic instability (odds ratio [OR] = 8.57, 95% confidence interval [CI] = 1.57-46.71;p = 0.013), consciousness disorder (OR = 19.18, 95% CI = 3.02-121.72];p = 0.002) or myocardial ischemia (OR = 6.28, 95% CI = 1.27-31.10;p = 0.013) were significantly associated with postoperative mortality. No patient was reoperated for aortic valve during the postoperative period. One patient suffered a stroke postoperatively with partial recovery. Kidney failure requiring temporary dialysis occurred in 12 patients (20.3%). At discharge, a transthoracic echocardiogram showed moderate aortic regurgitation (AR; grade 2) in two patients. During follow-up (mean = 58.4 +/- 32.4 months), three patients died. The rate of mortality was 6.2%. Actuarial survival at 5 years was 76.3%. No patient required reoperation on the proximal aorta or aortic valve. At 4 years, freedom from any aortic valve or root reintervention and AR > 2 were both 100%. Conclusion In a center with expertise in valve-sparing procedures, ARREAA is a reasonable option in the surgical management of AAAD in selected patients. This technique stabilizes the aortic annulus and preserves root anatomy for durable outcomes.
机译：背景：评估主动脉根部重塑与主动脉外环成形术（ARREAA）在急性A型主动脉夹层（AAAD）中的作用。方法2011年5月至2020年5月，240例AAAD患者中59例接受ARREAA治疗。对数据进行回顾性收集和分析。结果平均年龄61.4+/-8.6岁，男性43例（73%）。37例（62.7%）和14例（23.7%）患者进行了半弓和全弓置换术。主动脉瓣成形术7例（11.8%）。5名患者（8.5%）需要冠状动脉旁路移植术。6名患者（10.1%）需要再次探查出血。30天死亡率为18.6%。术前血流动力学不稳定（优势比[OR]=8.57，95%可信区间[CI]=1.57-46.71；p=0.013）、意识障碍（OR=19.18，95%CI=3.02-121.72）；p=0.002）或心肌缺血（OR=6.28，95%CI=1.27-31.10；p=0.013）与术后死亡率显著相关。术后没有患者因主动脉瓣再次手术。一名患者术后中风，部分康复。12例（20.3%）患者出现需要临时透析的肾衰竭。出院时，两名患者的经胸超声心动图显示中度主动脉瓣返流（AR；2级）。在随访期间（平均=58.4+/-32.4个月），三名患者死亡。死亡率为6.2%。5年的精算生存率为76.3%。没有患者需要对近端主动脉或主动脉瓣进行再次手术。4年时，无任何主动脉瓣或根部再干预，AR>2均为100%。结论在一个具有瓣膜保留手术专业知识的中心，ARREAA是选择患者进行AAAD手术治疗的合理选择。这项技术稳定了主动脉环，并保留了根部解剖结构，以获得持久的结果。

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