改良岛状吻合技术治疗不同年龄A型主动脉夹层的中远期结果差异  

Short-and long-term outcomes of the modified island technique treating type A aortic dissection patients in different age

作　　者：张晓阳 陈苏伟 贾博 里程楠[1] 乔志钰[1] 葛翼鹏[1] 胡海瓯[1] 朱俊明[1] ZHANG Xiao-yang;CHEN Su-wei;JIA Bo;LI Cheng-nan;QIAO Zhi-yu;GE Yi-peng;HU Hai-ou;ZHU Jun-ming(Department of Cardiovascular Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing Aortic Disease Center,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院心外科北京市心肺血管疾病研究所,北京市100029

出　　处：《中国心血管病研究》2025年第4期348-353,共6页Chinese Journal of Cardiovascular Research

基　　金：国家科技重大专项(2023ZD0504400)。

摘　　要：目的 回顾分析我院改良岛状吻合技术治疗不同年龄A型主动脉夹层(type A aortic dissection,TAAD)的短长期结果差异。方法 2018年1月至2022年7月共278例TAAD患者在北京安贞医院使用改良岛状吻合技术进行全主动脉弓部重建,按年龄分为青年组(<45岁)、中年组(45~59岁)、老年组(≥60岁),比较院内病死率、主要不良事件(major adverse events,MAEs)发生率和5年总生存率。结果 老年组院内病死率(25.00%比5.56%,P=0.001)及MAEs发生率(39.58%比14.81%,P=0.002)显著高于青年组。与中年患者相比,老年是院内死亡的独立风险因素[OR=4.04(1.11~14.70),P=0.034]。限制性立方样条图提示年龄和院内死亡呈显著的剂量反应关系(P_(总体)=0.002)。整个队列的5年总体生存率和免于再干预生存率分别为97.08%和92.58%,各组间无显著差异(P>0.05)。结论 改良岛状吻合技术可作为多年龄段TAAD患者的弓部重建技术。对于老年患者,其远期预后与青中年患者相近,但需严格评估围术期风险。Objective To retrospectively analyze the differences in the short-and long-term outcomes of modified island technique for treating type A aortic dissection(TAAD) across different age groups.Methods From January 2018 to July 2022,278 TAAD patients who underwent total arch replacement with modified island technique at Beijing Anzhen Hospital.They were divided into three age groups:the youth(<45 years),the middle-aged(45-59 years) and the elderly(≥60 years).The in-hospital mortality,incidence of major adverse events(MAEs) and 5-year overall survival rates were compared among the groups.Results The elderly group exhibited significantly higher in-hospital mortality(25.00% vs.5.56%,P=0.001) and MAEs incidence(39.58% vs.14.81%,P=0.002) compared to the youth group.Compared to middle-aged group,elderly age was identified as an independent risk factor for in-hospital death [OR 4.04(1.11-14.70),P=0.034].Restricted cubic spline analysis revealed a significant dose-response relationship between age and in-hospital death(P for overall=0.002).The overall survival and freedom from reintervention rates at 5-year were 97.08% and 92.58%,respectively,with no intergroup differences(P>0.05).Conclusion The modified island technique can be used for TAAD patients across multiple age groups.In elderly patients,the long-term outcomes is similar to that of young and middle-aged patients,but perioperative risks need to be critically evaluated.

关 键 词：A型主动脉夹层 年龄 改良岛状吻合技术 

分 类 号：R654.7[医药卫生—外科学]