Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Institute of Heart Lung and Blood Vessel Diseases, Beijing Engineering Research Center of Vascular Prostheses, Beijing, China.
Asian J Surg. 2020 Jan;43(1):213-219. doi: 10.1016/j.asjsur.2019.02.004. Epub 2019 Mar 14.
The aim of our study was to assess how much renal malperfusion increases the risk of early and late mortality in patients with acute type A aortic dissection (ATAAD) undergoing surgical repair.
This study included 218 patients with ATAAD undergoing surgical repair using the total arch replacement and frozen elephant trunk technique. Mean age was 47.8 ± 10.7 years and 170 were male (78.0%). Based on clinical symptoms and computed tomographic angiography (CTA) findings, 48 patients were diagnosed with preoperative renal malperfusion (22.0%). Clinical data were compared between two groups. The impact of renal malperfusion on operative and late mortality were evaluated with Cox regression.
Patients with renal malperfusion experienced significantly higher incidences of persistent postoperative acute kidney injury (AKI; 10/48, 20.8% vs 7/170, 4.1%; p < 0.001) and transient AKI (10/48, 20.8% vs 8/170, 4.7%; p = 0.001) as well as operative mortality (22.9%, 11/48 vs 8.3%, 14/170; p = 0.023). Five-year survival was significantly lower in the renal malperfusion group (72.9% vs 87.0%, p = 0.003). Renal malperfusion was the risk factor for operative mortality (hazard ratio, HR, 2.74; 95% CI, 1.07-6.99; p = 0.035) and overall mortality (HR, 2.64; 95% CI, 1.23-5.67; p = 0.013) but did not predict late death (HR, 2.46; 95% CI, 0.65-9.35; p = 0.187).
Renal malperfusion increases the risk of operative mortality by 3 times but did not affect late death in patients undergoing acute type A dissection repair.
本研究旨在评估急性 A 型主动脉夹层（ATAAD）患者手术修复时肾灌注不足对早期和晚期死亡率的影响。
本研究纳入了 218 例行全主动脉弓置换和冷冻象鼻技术手术修复的 ATAAD 患者。平均年龄为 47.8±10.7 岁，170 名为男性（78.0%）。根据临床症状和计算机断层血管造影（CTA）结果，48 名患者被诊断为术前肾灌注不足（22.0%）。比较两组患者的临床资料。采用 Cox 回归评估肾灌注不足对手术和晚期死亡率的影响。
肾灌注不足患者术后持续性急性肾损伤（AKI；10/48，20.8% vs 7/170，4.1%；p<0.001）和一过性 AKI（10/48，20.8% vs 8/170，4.7%；p=0.001）以及手术死亡率（22.9%，11/48 vs 8.3%，14/170；p=0.023）明显更高。肾灌注不足组 5 年生存率明显较低（72.9% vs 87.0%，p=0.003）。肾灌注不足是手术死亡率（风险比，HR，2.74；95%置信区间，1.07-6.99；p=0.035）和总死亡率（HR，2.64；95%置信区间，1.23-5.67；p=0.013）的危险因素，但不预测晚期死亡（HR，2.46；95%置信区间，0.65-9.35；p=0.187）。
肾灌注不足使急性 A 型主动脉夹层修复患者的手术死亡率增加 3 倍，但不影响晚期死亡率。
