Shemirani Hasan, Mirmohamadsadeghi Amir, Mahaki Behzad, Farhadi Sadaf, Badalabadi Reza Mohseni, Bidram Peyman, Badalabadi Mehdi Mohseni
Department of Cardiology, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Biostatistics, School of Public Health, University of Medical Sciences, Isfahan, Iran.
Adv Biomed Res. 2017 Jul 14;6:85. doi: 10.4103/2277-9175.210662. eCollection 2017.
Although aortic dissection is a rare disease, it causes high level of mortality. If ascending aorta gets involved in this disease, it is known as type A. According to small number of studies about this disease in Iran, this study conducted to detect the factors related to acute aortic dissection type A, its surgery consequences and the factors affecting them.
In this historical cohort study, all patients having acute aortic dissection type A referring to Chamran Hospital from 2006 to 2012 were studied. The impact of two surgical methods including antegrade cerebral perfusion (ACP) and retrograde cerebral one (RCP) on surgical and long-term mortality and recurrence of dissection was determined. The relation of mortality rate and hemodynamic instability before surgery, age more than 70 years old, ejection fraction lower than 50%, prolonged cardiopulmonary bypass pump (CPBP) time and excessive blood transfusion, was assessed.
Surgery and long-term mortality and recurrence of dissection were 35.3%, 30.8% and 30.4%. Surgical and long-term death in the patients being operated by ACP method was lower than those one being operated by RCP ( < 0.001). Excessive blood transfusion and unstable hemodynamic condition had significant effect on surgical mortality ( = 0.014, 0.030, respectively). CPBP time and unstable hemodynamic condition affected long-term mortality significantly ( = 0.002).
The result found that ACP is the preferable kind of surgery in comparison with RCP according to the surgical and long-term mortality.
尽管主动脉夹层是一种罕见疾病，但它会导致高死亡率。如果升主动脉受累于该疾病，则称为A型。根据伊朗关于这种疾病的少量研究，本研究旨在检测与急性A型主动脉夹层相关的因素、其手术后果以及影响这些因素的因素。
在这项历史性队列研究中，对2006年至2012年转诊至查姆兰医院的所有急性A型主动脉夹层患者进行了研究。确定了包括顺行脑灌注（ACP）和逆行脑灌注（RCP）在内的两种手术方法对手术和长期死亡率以及夹层复发的影响。评估了手术前死亡率与血流动力学不稳定、年龄超过70岁、射血分数低于50%、体外循环泵（CPBP）时间延长和大量输血之间的关系。
手术和长期死亡率以及夹层复发率分别为35.3%、30.8%和30.4%。采用ACP方法进行手术的患者的手术和长期死亡率低于采用RCP方法进行手术的患者（<0.001）。大量输血和血流动力学不稳定对手术死亡率有显著影响（分别为=0.014、0.030）。CPBP时间和血流动力学不稳定对长期死亡率有显著影响（=0.002）。
结果发现，根据手术和长期死亡率，与RCP相比，ACP是更可取的手术方式。
