Department of Cardiac Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4120, Australia.
Heart Lung Circ. 2010 Nov;19(11):665-72. doi: 10.1016/j.hlc.2010.05.009. Epub 2010 Jun 12.
The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).
Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.
The mean age was 61years; 60% were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45%, malperfusion syndrome in 59%, moderate-severe aortic regurgitation in 48% and tamponade in 16%. EF was <40% in 17%. There was a delay of >12hours between diagnosis and operation in 64%. Axillary cannulation was performed in 37%. Cerebral protection was by hypothermic arrest (HCA) alone (19%), HCA with retrograde cerebral perfusion (RCP) (11%), or HCA with antegrade cerebral perfusion (ACP) (46%). The procedure was performed on cross-clamp in 24%. Full arch replacement was performed in 14% and concomitant coronary artery grafting was performed in 11%. Post-operative neurological dysfunction was present in 33.8%. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53%. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70% at two years, 50% at five years and 25% at nine years. Functional outcomes and long-term quality of life were assessed in 69% of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.
Discharged patients have reasonable long-term survival and good quality of life.
本研究旨在确定急性 A 型主动脉夹层（AAAD）修复术后神经功能障碍、30 天死亡率、长期生存率和生活质量的预测因素。
2000 年至 2008 年间，65 例患者接受了 AAAD 修复。研究了 64 个术前、术中、术后变量。平均随访 26.6 个月。
平均年龄为 61 岁；60%为男性，5 例有马凡综合征。在发病时，45%的患者出现缺血性心电图改变，59%的患者出现灌注不良综合征，48%的患者出现中重度主动脉瓣反流，16%的患者出现心脏压塞。17%的 EF<40%。64%的患者在确诊和手术之间的时间超过 12 小时。37%的患者行腋动脉插管。脑保护采用单纯低温停循环（HCA）（19%）、HCA 联合逆行脑灌注（RCP）（11%）或 HCA 联合顺行脑灌注（ACP）（46%）。24%的患者在体外循环下进行手术。14%的患者行全弓置换，11%的患者行冠状动脉旁路移植术。术后有 33.8%的患者出现神经功能障碍。单因素分析显示，全弓置换术是不良神经结局的唯一显著预测因素（p=0.04）。住院期间的 30 天死亡率为 23.53%。死亡率的显著预测因素是低射血分数（p=0.017）和术后肾功能衰竭（p=0.012）。2 年生存率为 70%，5 年生存率为 50%，9 年生存率为 25%。在最后一次随访时存活的 69%的患者评估了功能结局和长期生活质量。90%的患者报告在功能评分上有最小的限制。生活质量使用 EQ-5D 问卷进行评估。48%的患者记录到完全健康，使用美国偏好加权指数评分的总体平均指数为 0.854（最好的评分是 1）。
出院患者有合理的长期生存率和良好的生活质量。
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