Thurau Jana, Habazettl Helmut, El Al Md Alaa Abd, Mladenow Alexander, Zaschke Lisa, Adam Md Uyanga, Kuppe Hermann, Wundram Maximilian, Kukucka Marian, Kurz Md Stephan D
Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany.
Institute of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Institute of Physiology, Berlin, Germany.
J Cardiothorac Vasc Anesth. 2019 Jan;33(1):51-57. doi: 10.1053/j.jvca.2018.07.046. Epub 2018 Aug 4.
The aim of this study was to analyze preoperative and postoperative echocardiographic parameters in patients with type-A acute aortic dissection (ATAAD) and to analyze whether impaired preoperative left ventricular function was associated with short- and long-term survival. To enable multivariable analysis, established risk factors of ATAAD were analyzed as well.
Retrospective single-center study.
The German Heart Center Berlin.
The retrospective data of 512 patients with ATAAD who were treated between 2006 and 2014 were analyzed.
None.
Preoperative versus postoperative left ventricular ejection fraction (LVEF), right ventricular ejection fraction, left ventricular end-diastolic diameter, and right ventricular end-diastolic diameter were not significantly different, and the mean values were within the reference ranges. Because of the surgical intervention, incidences and severities of aortic regurgitation and pericardial effusion decreased. In multivariable logistic analysis, the authors identified age (odds ratio [OR] 1.04, p < 0.001), preoperative LVEF ≤35% (OR 2.20, p = 0.003), any ischemia (Penn non-Aa) (OR 2.15, p < 0.001), and longer cardiopulmonary bypass time (OR 1.04, p < 0.001) as independent predictors of 30-day mortality. Cardiopulmonary resuscitation, tamponade, or shock, and pre-existing cardiac disease, were not predictors of death.
After surgery, aortic insufficiency and pericardial effusion decreased, whereas cardiac functional parameters did not change. Severe LV dysfunction was identified as a new independent predictor of 30-day mortality.
本研究旨在分析A型急性主动脉夹层（ATAAD）患者术前和术后的超声心动图参数，并分析术前左心室功能受损是否与短期和长期生存相关。为了进行多变量分析，还对已确定的ATAAD危险因素进行了分析。
回顾性单中心研究。
柏林德国心脏中心。
分析了2006年至2014年间接受治疗的512例ATAAD患者的回顾性数据。
无。
术前与术后左心室射血分数（LVEF）、右心室射血分数、左心室舒张末期直径和右心室舒张末期直径无显著差异，平均值在参考范围内。由于手术干预，主动脉瓣反流和心包积液的发生率及严重程度降低。在多变量逻辑分析中，作者确定年龄（比值比[OR]1.04，p<0.001）、术前LVEF≤35%（OR 2.20，p=0.003）、任何缺血（Penn非Aa）（OR 2.15，p<0.001）和较长的体外循环时间（OR 1.04，p<0.001）是30天死亡率的独立预测因素。心肺复苏、心包填塞或休克以及既往存在的心脏病不是死亡的预测因素。
手术后，主动脉瓣关闭不全和心包积液减少，而心脏功能参数未改变。严重左心室功能障碍被确定为30天死亡率的新独立预测因素。
