Afifi Rana O, Sandhu Harleen K, Leake Samuel S, Rice Rob D, Azizzadeh Ali, Charlton-Ouw Kristofer M, Nguyen Tom C, Miller Charles C, Estrera Anthony L, Safi Hazim J
University of Texas Medical School at Houston, Houston, Texas.
University of Texas Medical School at Houston, Houston, Texas; Memorial Hermann Heart and Vascular Institute, Houston, Texas.
Ann Thorac Surg. 2016 Jan;101(1):64-71. doi: 10.1016/j.athoracsur.2015.07.007. Epub 2015 Oct 1.
Acute type A aortic dissection (ATAAD) is a surgical emergency associated with high mortality and morbidity. We analyzed our 15-year experience in the management of ruptured ATAAD (rATAAD) and non-rATAAD to determine the predictors of early and late mortality.
We reviewed all cases with ATAAD between 1999 and 2014. Patients were grouped into rATAAD and non-rATAAD based on intraoperative confirmation. Clinical data on preoperative characteristics and in-hospital and long-term outcomes were analyzed to determine risk factors for early and long-term mortality. Survival was analyzed using Kaplan-Meier and log rank statistics.
Of the 489 total ATAAD repairs, 75 patients (15.3%) had rATAAD. The rATAAD patients were older compared with non-rATAAD (64.4 ± 16.2 versus 57.3 ± 14.2 years, respectively; p = 0.0001) and commonly female (31 of 75 [41.3%] versus 107 of 414 [25.9%], respectively; p = 0.006). Early mortality was higher among rATAAD patients that among non-rATAAD patients (19 of 75 [25.3%] versus 48 of 414 [11.6%], respectively; p = 0.002); predictors included rupture, age, malperfusion syndrome, and coronary artery disease. Patients aged 70 years or more with malperfusion syndrome had a 7.7-fold risk of 24-hour mortality (p = 0.0003) that was augmented by rATAAD (p = 0.004). Long-term survival was lower among rATAAD than non-rATAAD (57.4% versus 78.2%, respectively, at 5 years; p < 0.0001); independent predictors included rupture (p = 0.01), low glomerular filtration rate (p = 0.001), and high-risk group (p = 0.004). These risk factors were used to construct a predictive model for estimating the probability of early mortality in ATAAD.
Rupture is associated with significantly higher mortality in ATAAD. This predictive model provides surgical risk assessment for early mortality after rATAAD. For acceptable surgical candidates, immediate aortic repair can provide favorable outcomes.
急性A型主动脉夹层（ATAAD）是一种与高死亡率和高发病率相关的外科急症。我们分析了我们在15年中对破裂性ATAAD（rATAAD）和非破裂性ATAAD的治疗经验，以确定早期和晚期死亡率的预测因素。
我们回顾了1999年至2014年间所有ATAAD病例。根据术中确认情况将患者分为rATAAD组和非rATAAD组。分析术前特征、住院期间及长期预后的临床数据，以确定早期和长期死亡率的危险因素。采用Kaplan-Meier法和对数秩统计分析生存率。
在489例ATAAD修复手术中，75例（15.3%）为rATAAD。rATAAD患者比非rATAAD患者年龄更大（分别为64.4±16.2岁和57.3±14.2岁；p = 0.0001），且女性更为常见（75例中的31例[41.3%]和414例中的107例[25.9%]，分别；p = 0.006）。rATAAD患者的早期死亡率高于非rATAAD患者（分别为75例中的19例[25.3%]和414例中的48例[11.6%]；p = 0.002）；预测因素包括破裂、年龄、灌注不良综合征和冠状动脉疾病。年龄70岁及以上且患有灌注不良综合征的患者24小时死亡率风险增加7.7倍（p = 0.0003），rATAAD会进一步增加该风险（p = 0.004）。rATAAD患者的长期生存率低于非rATAAD患者（5年时分别为57.4%和78.2%；p < 0.0001）；独立预测因素包括破裂（p = 0.01）、低肾小球滤过率（p = 0.001）和高危组（p = 0.
