急性 A 型主动脉夹层修复的双重动脉插管策略：单中心 10 年经验。
Double arterial cannulation strategy for acute type A aortic dissection repair: A 10-year single-institution experience.
机构信息
Chang Gung University, College of Medicine, Taoyuan, Taiwan.
Department of Cardiothoracic and Vascular Surgery, Chang Gung Memorial Hospital, Linkou, Taiwan.
出版信息
PLoS One. 2019 Feb 6;14(2):e0211900. doi: 10.1371/journal.pone.0211900. eCollection 2019.
BACKGROUND
Repair of acute type A aortic dissection (ATAAD) is a complex and emergent cardiovascular surgery that is associated with high perioperative morbidity and mortality. Each cannulation strategy has different benefits and drawbacks during cardiopulmonary bypass. Using a retrospective study design, we aimed to clarify the safety and efficacy of right axillary artery cannulation in combination with femoral artery cannulation compared to single arterial cannulation for ATAAD repair.
METHODS
From January 2007 to July 2017, 476 adult patients underwent ATAAD repair at a single institution. Patients were classified into groups according to their cannulation strategy: the double arterial cannulation (DAC) group (n = 377; 79.2%) or single arterial cannulation (SAC) group (n = 99; 20.8%). Preoperative demographics, surgical information, and postoperative recovery were compared between both groups. Survival and freedom from reoperation rates were analyzed using the Kaplan-Meier actuarial method.
RESULTS
Demographics, comorbidities, and surgical procedures were generally homogenous between the two groups, except for sex, age, and rate of extensive aortic repair. Patients who underwent DAC had lower in-hospital mortality (13.5% vs. 25.3%; P = 0.005) and lower incidence of malperfusion-related complications (18.8% vs. 30.3%; P = 0.011) than those who underwent SAC. During multivariate analysis, SAC was identified as an in-hospital mortality predictor (odds ratio, 2.81; 95% confidence interval, 1.52-5.17; P = 0.001), as were preoperative ventilator support, intraoperative extracorporeal membrane oxygenation installation, and postoperative malperfusion-related complications. Three-year cumulative survival and freedom from reoperation rates were 74.8% and 85.3% for the DAC group and 62.6% and 81.1% for the SAC group, respectively (P = 0.010 and 0.430, respectively).
CONCLUSIONS
With acceptable short- and mid-term outcomes, DAC is effective and safe for establishing cardiopulmonary bypass during ATAAD repair.
背景
急性 A 型主动脉夹层（ATAAD）的修复是一种复杂且紧急的心血管手术，其围手术期发病率和死亡率较高。在体外循环过程中，每种插管策略都有不同的优缺点。我们采用回顾性研究设计，旨在明确右腋动脉插管联合股动脉插管与单一动脉插管在 ATAAD 修复中的安全性和疗效。
方法
2007 年 1 月至 2017 年 7 月，一家机构共对 476 例成人 ATAAD 患者进行了手术修复。患者根据插管策略分为两组：双动脉插管（DAC）组（n = 377；79.2%）或单动脉插管（SAC）组（n = 99；20.8%）。比较两组患者的术前人口统计学、手术信息和术后恢复情况。采用 Kaplan-Meier 生存分析法分析生存率和免于再次手术率。
结果
两组患者的一般人口统计学、合并症和手术过程基本相似，仅性别、年龄和广泛主动脉修复率存在差异。DAC 组患者的院内死亡率（13.5%比 25.3%；P = 0.005）和吻合口相关并发症发生率（18.8%比 30.3%；P = 0.011）较低。多因素分析显示，SAC 是院内死亡的预测因子（比值比，2.81；95%置信区间，1.52-5.17；P = 0.001），术前呼吸机支持、术中体外膜氧合安装和术后吻合口相关并发症也是院内死亡的预测因子。DAC 组患者的 3 年累积生存率和免于再次手术率分别为 74.8%和 85.3%，SAC 组患者分别为 62.6%和 81.1%（P = 0.010 和 0.430）。
结论
DAC 建立体外循环用于 ATAAD 修复时，具有可接受的短期和中期效果，且安全有效。
Zotero 插件