초록접수 현황
| 15F-155 | 구연 발표 |
The Clinical Outcomes of Different Technique for Proximal Descending Thoracic Aneurysm Involving Distal Arch
Hyun-chel Joo, Seung-hyun Lee, sak Lee, Byung-chul Chang, Kyung-jong Yoo, Young-Nam Youn
Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
Background : The aim of the study was to evaluate clinical outcomes of different approaches, including hybrid procedures, to aortic pathologies with proximal descending thoracic aneurysm (DTA) involving distal arch
Methods : From January 2003 to July 2015, 191 consecutive patients with proximal descending aorta aneurysm involving distal arch underwent surgery as different approaches: total arch and DTA replacement via sternotomy (TAR group, n=77) or hemiarch and DTA replacement via thoracotomy (DTR group, n=74) or hybrid arch repair (HAR group, n=40). We retrospectively evaluated the outcomes of the three groups. The mean follow up duration was 43.4 months.
Results : The 30-day mortality was 3.9 % (3/77) in the TAR group, 8.1% (8/74) in the DTR group and 5.0 % (2/40) in the HAR group, respectively (p = 0.525). The TAR group showed the lower incidence of stroke (3.9 %, 3/77) compared with the DTR group (12.2 %, 9/74) and HAR group (10 %, 4/40) (p=0.171). The HAR group showed the lower incidence of pulmonary complication (5%, 2/40) compared with TAR group (19.5%, 15/77) and DTR group (20.3%, 15/74) (p=0.04). The 10-year survival rates were 81.3 ± 6.9 % for TAR repair, 62.9 ± 11.1% for DTR group and 57.0 ± 13.3 % for HAR repair (p=0.04). The 10-year freedom from re-intervention were 85.1± 6.7% for TAR repair, 87.3 ± 7.8% for DTR repair and 36.4 ± 16.4 % for HAR group (p<0.01).
Conclusion : For treatment aortic pathologies with proximal DTA involving distal arch, TAR approach showed better outcomes in terms of operative mortality and stroke as well as long-term survival compared with thoracotomy or hybrid approach. Hybrid repair remains controversial regarding to perioperative stroke and long-term durability. TAR approach would be suggested as superior option for patients with proximal DTA involving distal arch.
Methods : From January 2003 to July 2015, 191 consecutive patients with proximal descending aorta aneurysm involving distal arch underwent surgery as different approaches: total arch and DTA replacement via sternotomy (TAR group, n=77) or hemiarch and DTA replacement via thoracotomy (DTR group, n=74) or hybrid arch repair (HAR group, n=40). We retrospectively evaluated the outcomes of the three groups. The mean follow up duration was 43.4 months.
Results : The 30-day mortality was 3.9 % (3/77) in the TAR group, 8.1% (8/74) in the DTR group and 5.0 % (2/40) in the HAR group, respectively (p = 0.525). The TAR group showed the lower incidence of stroke (3.9 %, 3/77) compared with the DTR group (12.2 %, 9/74) and HAR group (10 %, 4/40) (p=0.171). The HAR group showed the lower incidence of pulmonary complication (5%, 2/40) compared with TAR group (19.5%, 15/77) and DTR group (20.3%, 15/74) (p=0.04). The 10-year survival rates were 81.3 ± 6.9 % for TAR repair, 62.9 ± 11.1% for DTR group and 57.0 ± 13.3 % for HAR repair (p=0.04). The 10-year freedom from re-intervention were 85.1± 6.7% for TAR repair, 87.3 ± 7.8% for DTR repair and 36.4 ± 16.4 % for HAR group (p<0.01).
Conclusion : For treatment aortic pathologies with proximal DTA involving distal arch, TAR approach showed better outcomes in terms of operative mortality and stroke as well as long-term survival compared with thoracotomy or hybrid approach. Hybrid repair remains controversial regarding to perioperative stroke and long-term durability. TAR approach would be suggested as superior option for patients with proximal DTA involving distal arch.
책임저자: Young-Nam Youn
Department of Cardiovascular Surgery, Yonsei Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Republic of Korea
연락처 : Hyun-chel Joo, Tel: 02-2228-8489 , E-mail : vietcomm@yuhs.ac
