| Objective: To observe the effect of different timing of thoracic endovascular aortic repair(TEVAR)on the efficacy of Stanford type B aortic dissection in the acute phase,and to explore the most appropriate time for TEVAR in the treatment of Stanford type B aortic dissection in the acute phase.Methods: The clinical data of Stanford type B aortic dissection patients previously hospitalized in the Department of Cardiovascular Surgery of our hospital from January 2016 to December 2020 were selected and divided into non-surgical group(without endovascular aortic repair in the acute phase)and surgical group(with endovascular aortic repair in the acute phase)according to whether they underwent endovascular aortic repair(TEVAR)in the acute phase(Onset time ≤ 14 days);the surgical group was subdivided into: group A(within 3 days from onset to surgery),group B(within 3-5 days from onset to surgery),and group C(more than 5 days from onset to surgery)according to the time from onset to surgery.Perioperative general data,mortality,main postoperative complications(endoleak,stroke,paraplegia,recurrence of new type B dissection,reverse avulsion to form type A dissection,pain)and aortic diameter in each plane before and after surgery were collected between the groups,respectively.The results between the groups were statistically analyzed and compared,and the discussion was summarized.Results: the non-surgical group and 98 in the surgical group(22 in group A,30 in group B,and 46 in group C).(1)Preoperative general data: The age of patients in non-surgical group was older than that in surgical group(63.8 ± 11.8 years vs 56.2 ± 11.1 years,P < 0.01),and there was no sig A total of 148 patients with Stanford type B aortic dissection were collected in this study,50 in nificant difference in other general data(P > 0.05);there was no significant difference in surgical general data(P > 0.05).(2)Surgery and reintervention: 98 cases of TEVAR surgery,the success rate of 100%,a total of 48 cases using auxiliary techniques,the auxiliary rate of 49.0%,8 cases of reoperation intervention,the reintervention rate of 8.2%.There was no statistical difference in the use of auxiliary techniques in the surgical group(54.5% vs 50.0% vs 45.7%,P > 0.05),and there was no statistical difference in the reintervention in the surgical group(9.1% vs 10% vs 6.5%,P >0.05).(3)Mortality within 15 days: The mortality rate of the non-surgical group was higher than that of the surgical group(10.0% vs 2.0%,P = 0.04);the mortality rate of the surgical group A was higher than that of the B group C(9.0% vs 0% vs 0%,P = 0.04).(4)Incidence of endoleak: There was no significant difference within the surgical group(0% vs 0% vs2.2%,P > 0.05).(5)Incidence of paraplegia: There was no significant difference within the surgical group(0% vs 3.3% vs 0%,P > 0.05).(6)Incidence of stroke: There was no significant difference within the surgical group(0% vs 3.3% vs 4.3%,P > 0.05).(7)Incidence of postoperative pain: There was no significant difference within the surgical group(9.0% vs 10.0% vs 4.3%,P > 0.05).(8)Incidence of type A dissection formed by reverse avulsion: There was no significant difference within the surgical group(0% vs 3.3%vs 2.2%,P > 0.05).(9)Incidence of recurrent new type B dissection: There was no significant difference within the surgical group(0% vs 3.3% vs 4.3%,P > 0.05).(10)Incidence of major postoperative complications: There was no significant difference within the surgical group(18.2% vs 23.3% vs 17.4%,P > 0.05).(11)Aortic remodeling: There were no statistically significant differences in postoperative false lumen diameter change values,FLi,and Tli in the maximum false lumen plane,tracheal rumen plane,diaphragmatic plane,and celiac trunk plane among the three groups(P > 0.05).Conclusion: 1,TEVAR surgery,as a first-line treatment for type B aortic dissection,has a high success rate,safety,and good efficacy.2.TEVAR should be performed as early as possible in Stanford type B aortic dissection to reduce the possibility of death caused by its rupture. |
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