主动脉弓部病变不同弓上分支重建技术的疗效分析:单中心13年经验

Clinical analysis of branch reconstruction methods for aortic arch diseases:A single center experience for 13 years

目的比较主动脉弓部病变不同弓上分支重建技术的临床疗效。方法回顾性分析2010~2022年在中山大学附属第一医院接受弓上分支动脉重建的160例患者资料。根据主动脉弓上分支重建方法,将患者分为烟囱组(74例)、开窗组(19例)和分支组(67例),评估不同重建方式的短期及长期疗效。结果三组技术成功率均为100%。分支组围术期并发症发生率及二次干预率明显少于其他两组(并发症发生率:烟囱组23.0%,开窗组21.1%,分支组7.5%,P=0.037;二次干预率:烟囱组6.8%,开窗组15.8%,分支组1.5%,P=0.049)。总体随访率为89.2%,烟囱组、开窗组和分支组的中位随访时间分别为48、40.5和15个月。三组在全因死亡和并发症发生率的差异有统计学意义(全因死亡:烟囱组33.9%,开窗组11.1%,分支组3.3%,P<0.001;并发症发生率:烟囱组29.0%,开窗组11.1%,分支组11.7%,P=0.015)。Kaplan-Meier生存分析结果显示,50个月内除免于并发症发生率(P=0.049)外,烟囱、开窗和分支组累积生存率(P=0.249)、免于主动脉疾病相关死亡率(P=0.664)和免于二次干预率(P=0.753)差异有统计学意义。结论三种主动脉弓部病变弓上分支重建技术均安全有效,但烟囱技术远期内漏发生率较高,分支技术短期及远期效果较好。

Objective To compare the clinical outcomes of different aortic arch reconstruction techniques for patients with aortic arch diseases.Methods The clinical data of 160 patients with aortic arch disease who underwent branch vessel reconstruction at the First Affiliated Hospital of Sun Yat-sen University between 2010 and 2022 were analyzed retrospectively.The patients were divided into chimney group(n=74),fenestration group(n=19)and branch group(n=67)according to the method of aortic arch reconstruction.The short-term and long-term outcomes of different reconstruction methods were evaluated.Results The three groups had a success rate of 100%.Perioperative complication rate(chimney group vs fenestration group vs branch group:23.0%vs 21.1%vs 7.5%,P=0.037)and re-intervention rate(chimney group vs fenestration group vs branch group:6.8%vs 15.8%vs 1.5%,P=0.049)were significantly lower in branch group.The overall follow-up rate was 89.2%,and the median follow-up time for the chimney group,fenestration group,and branch group was 48 months,40.5 months and 15 months,respectively.There was a significant difference in overall mortality(chimney group vs fenestration group vs branch group:33.9%vs 11.1%vs 3.3%,P<0.001)and complication rate(chimney group vs fenestration group vs branch group:29.0%vs 11.1%vs 11.7%,P=0.015)between the three groups.The Kaplan-Meier survival analysis show that except for the complication rate (P=0.049), the cumulative survival rate (P=0.249), the rate of free from aortic disease-related mortality (P=0.664), and the rate of secondary intervention (P=0.753) were not significantly different among the chimney, fenestration and branch groups. Conclusion All three reconstruction methods for aortic arch diseases are safe and effective, but the chimney technique has a higher rate of endoleaks, and the branch technique shows better short-term and long-term effects.