Pagni Sebastian, Ganzel Brian L, Trivedi Jaimin R, Singh Ramesh, Mascio Christopher E, Austin Erle H, Slaughter Mark S, Williams Matthew L
Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
J Card Surg. 2013 Sep;28(5):543-9. doi: 10.1111/jocs.12170. Epub 2013 Aug 2.
Surgical repair of acute Type A aortic dissection (AADA) is still associated with high in-hospital mortality. We evaluated the impact of perioperative risk factors on early and midterm survival.
Retrospective (2002-2011) database analysis at a single institution of 132 consecutive AADA patients (88 male, age 59.8 ± 13.6). All but five patients underwent repair with open distal anastomoses and hypothermic circulatory arrest: aortic valve replacement/root replacement (n=44, 33.3%) and valve re-suspension/repair (n=88, 66.7%). Ascending aorta, hemi-arch, and total arch repairs were performed in 11, 113, and eight patients, respectively. Antegrade and retrograde cerebral perfusion were used in all but six patients.
Overall in-hospital mortality was 17.4% (n=23). Actuarial survival at one, five, and eight years was 82%, 72%, and 62%, respectively. Perfusion time (cardiopulmonary bypass) (226.5 ± 71.3 vs. 177.5 ± 51.7, p=0.0002), aortic cross-clamp time (min) (132.8 ± 45.7 vs. 109.8 ± 41.2, p=0.01), aortic arch (T2) tear (31% vs. 14%, p=0.03), instability (26% vs. 11%, p=0.02), postoperative stroke (38% vs. 14%, p=0.009), and low cardiac output (50% vs. 15%, p=0.04) all correlated with increased perioperative mortality. A Cox proportional hazard model showed perfusion time (hazard ratio [HR]=1.01), postoperative stroke (HR=2.73), age (HR=1.03), and unstability (HR=1.8) as significant risk factors (p<0.05) affecting the overall survival.
There is a modern trend towards improving overall perioperative outcomes after surgical repair of AADA; however, early mortality and morbidity remain high even in aortic surgery referral centers.
急性A型主动脉夹层（AADA）的外科修复术后院内死亡率仍居高不下。我们评估了围手术期危险因素对早期和中期生存的影响。
对一家机构2002年至2011年期间连续收治的132例AADA患者（88例男性，年龄59.8±13.6岁）进行回顾性数据库分析。除5例患者外，所有患者均采用开放远端吻合和低温循环停止进行修复：主动脉瓣置换/根部置换（n = 44，33.3%）和瓣膜重新悬吊/修复（n = 88，66.7%）。分别对11例、113例和8例患者进行升主动脉、半弓和全弓修复。除6例患者外，所有患者均采用顺行和逆行脑灌注。
总体院内死亡率为17.4%（n = 23）。1年、5年和8年的精算生存率分别为82%、72%和62%。灌注时间（体外循环）（226.5±71.3 vs. 177.5±51.7，p = 0.0002）、主动脉阻断时间（分钟）（132.8±45.7 vs. 109.8±41.2，p = 0.01）、主动脉弓（T2）撕裂（31% vs. 14%，p =
