Keeling William B, Leshnower Bradley G, Thourani Vinod H, Kilgo Patrick S, Chen Edward P
Division of Cardiothoracic Surgery, University of Louisville, Louisville, KY, USA.
Interact Cardiovasc Thorac Surg. 2012 Jul;15(1):63-8. doi: 10.1093/icvts/ivs127. Epub 2012 Apr 3.
Proximal thoracic aortic reconstruction performed with or without hypothermic circulatory arrest (HCA) is an effective surgical strategy for aortic pathology. In this study, the clinical outcomes of patients undergoing reoperative proximal thoracic aortic surgery were evaluated. A retrospective review was performed for reoperative proximal aortic surgery from 2004 to date. Patient data were abstracted from the society of thoracic surgeons (STS) institutional database and patient charts. Univariate analysis was conducted on the HCA group in order to determine the impact of variables on in-hospital mortality. Kaplan-Meier survival estimates were calculated for long-term survival analysis. One hundred and twenty-two patients were included in the analysis. Twenty-seven (22.1%) were female, and the mean age was 53.8 years. Seventy-seven (63.1%) patients had an aortic root replacement, and 93 (76.2%) patients underwent aortic arch replacement. Circulatory arrest was performed in 92 (75.4%) patients. Operative mortality occurred in 14 patients (11.5%). Complications included re-exploration for haemorrhage (nine patients, 7.4%), stroke (four, 3.3%), renal failure (13, 10.7%) and major adverse events (18, 14.8%). Univariate and multivariate analyses of HCA patients showed cardiopulmonary bypass (CPB) time, preoperative renal failure and prior coronary revascularization as independent predictors of mortality. Reoperative proximal aortic surgery can be performed with acceptable morbidity and mortality. These data also suggest that HCA represents a safe operative strategy for this patient population.
采用或不采用低温循环停止（HCA）进行近端胸主动脉重建是治疗主动脉病变的一种有效手术策略。在本研究中，对接受再次手术的近端胸主动脉手术患者的临床结局进行了评估。对2004年至今接受再次手术的近端主动脉手术进行了回顾性研究。患者数据从胸外科医师协会（STS）机构数据库和患者病历中提取。对HCA组进行单因素分析，以确定各变量对住院死亡率的影响。计算Kaplan-Meier生存估计值用于长期生存分析。122例患者纳入分析。27例（22.1%）为女性，平均年龄53.8岁。77例（63.1%）患者进行了主动脉根部置换，93例（76.2%）患者进行了主动脉弓置换。92例（75.4%）患者进行了循环停止。14例患者（11.5%）发生手术死亡。并发症包括因出血再次手术（9例，7.4%）、中风（4例，3.3%）、肾衰竭（13例，10.7%）和主要不良事件（18例，14.8%）。对HCA患者的单因素和多因素分析显示，体外循环（CPB）时间、术前肾衰竭和既往冠状动脉血运重建是死亡率的独立预测因素。再次手术的近端主动脉手术可以在可接受的发病率和死亡率下进行。这些数据还表明，HCA对该患者群体是一种安全的手术策略。
