用冷冻象鼻重建牙弓后的中期结果，一项单中心研究,Journal of Cardiothoracic Surgery

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用冷冻象鼻重建牙弓后的中期结果，一项单中心研究
Journal of Cardiothoracic Surgery ( IF 1.5 ) Pub Date : 2023-01-22 , DOI: 10.1186/s13019-023-02140-5
Therese Schagerholm Dahl ₁ , Rickard P F Lindblom _{1,

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Affiliation

主动脉弓和胸降主动脉近端手术可以挽救生命，但也与显着的发病率相关，从轻微感染到严重的神经功能障碍，以及很高的死亡风险。本研究的目的是临床评估结果，特别是神经损伤，以及寻求确定两个具有不同基础主动脉病变、动脉瘤和夹层、接受弓形/降主动脉手术的患者组的院内死亡率的预测因子修理。34 名患者（17 个动脉瘤，17 个夹层）接受了涉及主动脉弓和/或降主动脉的手术，使用 Thoraflex 或 E-Vita 冷冻象鼻移植物。40% 是女性。对动脉瘤与夹层进行了亚组分析。平均随访时间为 53.9 个月，平均年龄为 63.5 岁。住院死亡率为 18%。动脉瘤和夹层的存活率相当。脊髓损伤的发生率为 9%，中风发生率为 9%。67% 的人患有任何形式的神经系统疾病，其中还包括认知障碍。围手术期再手术率为29%（出血21%，内脏缺血6%，感染2%），术后需要透析11%，房颤、胸膜穿刺等一系列其他轻微并发症也很常见。术后透析被发现是院内死亡率的预测因素，而无论术前诊断如何，透析以及因出血和/或内脏缺血再次手术都会增加总体死亡率的风险。既往或当前吸烟似乎与随访期间的院内死亡率和总体死亡率相关。试注册追溯注册。

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Intermediate outcomes following arch reconstruction with frozen elephant trunk, a single centre study

Surgery on the aortic arch and proximal descending thoracic aorta can be lifesaving but is also associated with significant morbidity, ranging from minor infections to severe neurological impairments as well as a substantial risk of mortality. The aim of this study is to clinically assess outcomes, with special regards to neurologic injury, as well as to seek to identify predictors of in-hospital mortality in two patient groups with different underlying aortic pathology, aneurysms and dissections, undergoing arch/descending aortic repair. 34 patients (17 aneurysms, 17 dissections) underwent surgery involving the arch and/or descending aorta, using the Thoraflex or E-Vita frozen elephant trunk graft. 40% were female. Subgroup analysis of aneurysms compared to dissections were performed. Mean follow-up time was 53.9 months and mean age 63.5 years. In-hospital mortality was 18%. Survival was comparable between aneurysms and dissections. Incidence of spinal cord injury was 9% and stroke 9%. 67% suffered any form of neurological affection, when also cognitive afflictions were included. Perioperative reoperation rate was 29% (bleeding 21%, visceral ischemia 6%, infection 2%), the need for postoperative dialysis was 11% and a series of other minor complications such as atrial fibrillation and pleurocentesis were common. Postoperative dialysis was found to be a predictor of in-hospital mortality, while both dialysis as well as reoperation due to bleeding and/or visceral ischemia increased the risk for overall mortality, irrespective of preoperative diagnosis. Previous or current smoking appeared to be associated with negative outcomes regarding both in-hospital and overall mortality during follow-up. Trial registration Retrospectively enrolled.

更新日期：2023-01-23

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