Eghbalzadeh Kaveh, Sabashnikov Anton, Weber Carolyn, Zeriouh Mohamed, Djordjevic Ilija, Merkle Julia, Shostak Olga, Saenko Sergey, Majd Payman, Liakopoulos Oliver, Rahmanian Parwis B, Madershahian Navid, Choi Yeong-Hoon, Kuhn-Régnier Ferdinand, Wippermann Jens, Wahlers Thorsten
Department of Cardiothoracic Surgery, University Hospital of Cologne, Kerpener Str. 62, Cologne 50937, Germany.
Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
Ther Adv Cardiovasc Dis. 2018 Nov;12(11):289-298. doi: 10.1177/1753944718798345. Epub 2018 Sep 19.
The aim of the present study was to determine whether raised preoperative serum creatinine affected the long-term outcome in patients undergoing surgical aortic repair for Stanford A acute aortic dissection (AAD).
A total of 240 patients diagnosed with Stanford A AAD underwent surgical repair from January 2006 to April 2015. A propensity score matching was applied, resulting in 73 pairs consisting of one group with normal and one group with preoperative elevated creatinine levels. The cohorts were well balanced for baseline and preoperative clinical characteristics. Both groups were compared regarding their early postoperative variables, as well as estimated survival with up to 9-year follow up. Also, the impact of acute postoperative kidney injury and its severity on long-term survival was analyzed.
The proportion of patients suffering Stanford A AAD with raised creatinine levels was 31.3% ( n = 75). After propensity matching, there were no statistically significant differences regarding demographics, comorbidities, preoperative baseline and clinical characteristics. Postoperatively matched patients with elevated creatinine had longer intensive care unit ( p < 0.001) and total hospital stay ( p = 0.002), prolonged intubation times ( p = 0.014), higher need for hemofiltration ( p < 0.001), higher incidence of temporary neurological disorders ( p = 0.16), infection ( p = 0.005), and trend toward higher incidence of sepsis ( p = 0.097). However, there were no significant differences regarding 30-day mortality (20.5% versus 20.5%, p = 1.000) and long-term overall survival. Further, neither the incidence nor the different stages of acute kidney injury according to the Acute Kidney Injury Network showed any statistically significant differences in terms of long-term survival for both groups [log rank p = 0.636, Breslow (generalized Wilcoxon) p = 0.470, Tarone-Ware p = 0.558].
Patients with elevated creatinine levels undergoing surgical repair for Stanford A AAD demonstrate higher rate of early postoperative complications. However, 30-day mortality and long-term survival in this patient cohort is not significantly impaired.
本研究旨在确定术前血清肌酐升高是否会影响接受斯坦福A型急性主动脉夹层（AAD）手术主动脉修复患者的长期预后。
2006年1月至2015年4月，共有240例诊断为斯坦福A型AAD的患者接受了手术修复。应用倾向评分匹配法，得到73对匹配组，一组肌酐水平正常，另一组术前肌酐水平升高。两组在基线和术前临床特征方面均衡良好。比较两组术后早期变量以及长达9年随访期的估计生存率。此外，分析了术后急性肾损伤及其严重程度对长期生存的影响。
肌酐水平升高的斯坦福A型AAD患者比例为31.3%（n = 75）。倾向匹配后，在人口统计学、合并症、术前基线和临床特征方面无统计学显著差异。匹配后的肌酐升高患者术后在重症监护病房的时间更长（p < 0.001）、总住院时间更长（p = 0.002）、插管时间延长（p = 0.014）、血液滤过需求更高（p < 0.001）、短暂性神经功能障碍发生率更高（p = 0.16）、感染发生率更高（p = 0.005），且脓毒症发生率有升高趋势（p = 0.097）。然而，30天死亡率（20.5%对20.5%，p = 1.000）和长期总体生存率无显著差异。此外，根据急性肾损伤网络标准，急性肾损伤的发生率及不同阶段在两组长期生存方面均无统计学显著差异[对数秩检验p = 0.636，Breslow（广义Wilcoxon）检验p = 0.470，Tarone-Ware检验p = 0.558]。
肌酐水平升高的斯坦福A型AAD患者接受手术修复后早期术后并发症发生率更高。然而，该患者队列的30天死亡率和长期生存率并未受到显著影响。
