TEVAR逆撕A型夹层外科修复的安全性和预后评估

The safety and prognosis assessment of surgical repair for retrograde type A aortic dissection after TEVAR

目的分析胸主动脉腔内修复术(TEVAR)后逆撕A型夹层(RTAD)外科修复的安全性和预后。方法采用回顾性队列研究设计, 检索广东省人民医院病历数据库, 选取2017年12月至2020年8月接受TEVAR手术后在我院因RTAD接受再次主动脉手术的患者。收集患者的术前特征、TEVAR介入术和再次主动脉手术的详情, 以及术后随访数据。通过电话及门诊随访, 使用描述性统计的方法进行统计分析。结果纳入研究18例, 其中男17例, 平均年龄53.3岁。术前合并病史包括高血压病12例、冠心病2例和腹主动脉瘤1例。术后住院期间死亡1例, 心功能、肾功能障碍各1例, 再次手术2例。结论尽管TEVAR已被广泛应用, 但仍需要谨慎考虑患者的术前风险因素, TEVAR术后发生RTAD的患者接受主动脉外科手术安全有效。

Objective:To explore the safety and prognosis for surgical repair of retrograde type A aortic dissection(RTAD)following thoracic endovascular aortic repair(TEVAR).Methods:This study utilized a retrospective cohort design,searching the hospital's medical records database to select patients who underwent TEVAR surgery from December 2017 to August 2020 and subsequently received another aortic surgery in our hospital due to RTAD.We collected data on patients'preoperative characteristics,details of the TEVAR procedure and the subsequent aortic surgeries,as well as postoperative follow-up data.Follow-up for these patients was conducted via telephone and outpatient visits,and data were analyzed using descriptive statistical methods.Results:The study included a total of 18 patients,of whom 17 were males,with an average age of 53.3 years old.Preoperative comorbidities included hypertension in 12 patients,abdominal aortic aneurysm in 1 patient,and coronary heart disease in 2 patients.There was 1 in-hospital death,1 patient developed cardiac dysfunction,1 experienced renal impairment,and 2 required a re-entry into the operating room for further management.Conclusion:Despite the widespread use of TEVAR,it is essential to carefully consider a patient's preoperative risk factors,patients who develop RTAD after TEVAR can safely and effectively undergo aortic surgical repair.