Matsuura Kaoru, Ogino Hitoshi, Matsuda Hitoshi, Minatoya Kenji, Sasaki Hiroaki, Yagihara Toshikatsu, Kitamura Soichiro
Department of Cardiovascular Surgery, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan.
Eur J Cardiothorac Surg. 2005 Sep;28(3):473-7. doi: 10.1016/j.ejcts.2005.05.016.
The number of aortic surgeries has recently increased, with improvement of outcome due to the development of various novel operative techniques and adjuncts. Although the postoperative incidence of stroke, the most severe complication of aortic surgery, is still a matter of concern and has been described well previously, late stroke after aortic arch repair has not been described well. We assessed the incidence and predictors of late stroke after total aortic arch repair.
From January 1993 to December 2003, 470 patients underwent total aortic arch repair in our institution. All patients, whether undergoing elective, urgent, or emergent aortic arch repair, were included. Emergent operation was required for 115 patients because of rupture or acute type A dissection. For brain protection, retrograde cerebral perfusion was used in 27% (125) and selective cerebral perfusion in 75% (353) of cases. The follow-up period was 32.5+/-31.5 months. Late stroke was defined as stroke occurring more than 30 days postoperatively.
The incidence of early postoperative stroke was 4.9% (23/470), while that of late postoperative stroke was 6.0% (28/470). On univariate analysis, postoperative atrial fibrillation (P=0.014), preoperative prevalence of craniocervical lesions (P=0.0001), and advanced age (P=0.046) were each significantly related to late stroke. A Cox proportional hazards model detected postoperative atrial fibrillation (P=0.013, OR=3.02, 95% CI: 1.26-7.24) and preoperative prevalence of craniocervical lesions (P=0.0001, OR=5.37, 95% CI: 2.30-12.52) as predictors of late stroke.
Postoperative atrial fibrillation and preoperative prevalence of craniocervical lesions were found to be risk factors for late stroke after total aortic arch repair.
随着各种新型手术技术和辅助手段的发展，主动脉手术数量最近有所增加，手术效果也有所改善。尽管中风是主动脉手术最严重的并发症，其术后发生率仍是一个令人担忧的问题，且此前已有详细描述，但主动脉弓修复术后的迟发性中风尚未得到充分描述。我们评估了全主动脉弓修复术后迟发性中风的发生率及预测因素。
1993年1月至2003年12月，我院470例患者接受了全主动脉弓修复术。所有患者，无论接受择期、急诊或紧急主动脉弓修复，均纳入研究。115例患者因破裂或急性A型夹层而需要急诊手术。为保护大脑，27%（125例）采用逆行脑灌注，75%（353例）采用选择性脑灌注。随访期为32.5±31.5个月。迟发性中风定义为术后30天以上发生的中风。
术后早期中风发生率为4.9%（23/470），而术后迟发性中风发生率为6.0%（28/470）。单因素分析显示，术后房颤（P=0.014）、术前颅颈病变患病率（P=0.0001）和高龄（P=0.046）均与迟发性中风显著相关。Cox比例风险模型检测到术后房颤（P=0.013，OR=3.02，95%CI：1.26-7.24）和术前颅颈病变患病率（P=0.0001，OR=5.37，95%CI：2.30-12.52）是迟发性中风的预测因素。
术后房颤和术前颅颈病变患病率是全主动脉弓修复术后迟发性中风的危险因素。
