Division of Cardiovascular Surgery, Japanese Red Cross Kobe Hospital, Kobe, Japan.
Division of Cardiovascular Surgery, Hyogo Emergency Medical Center, Kobe, Japan.
Ann Thorac Surg. 2020 Oct;110(4):1357-1363. doi: 10.1016/j.athoracsur.2020.01.078. Epub 2020 Mar 7.
Cardiac tamponade with acute aortic dissection type A can cause fatal outcomes. We previously reported excellent outcomes using percutaneous pericardial drainage with controlled volumes of aspirated pericardial effusion (controlled pericardial drainage [CPD]) to stabilize patients with critical cardiac tamponade. This study evaluates the early and late outcomes using this approach.
Between September 2003 and July 2018, 308 patients with acute aortic dissection type A were treated surgically, including 76 patients who presented with cardiac tamponade on hospital arrival. Forty-nine patients who did not respond to intravenous volume resuscitation underwent CPD in the emergency room, including 14 patients (28.6%) who presented with cardiopulmonary arrest. After CPD 39 patients (79.6%) were transferred to the operating room to undergo immediate aortic repair. The remaining 10 patients (20.4%) received medical treatment on arrival, followed by aortic repair within several days.
In 49 patients the mean systolic blood pressure before CPD was 64.4 ± 10.3 mm Hg. Blood pressure rose significantly in all patients after CPD. The total volume of aspirated pericardial effusion was 46.8 ± 56.2 mL, and 30 of 49 patients (61%) required only 30 mL or less of aspiration to improve their blood pressure. All patients underwent successful aortic repair. Early hospital mortality was 16%. However there was no mortality related to CPD. The mean follow-up period was 52.9 ± 54.3 months. The cumulative survival rate was 63.4% after 5 years.
CPD for critical cardiac tamponade with acute type A aortic dissection produced satisfactory early and late outcomes.
急性主动脉夹层 A 型合并心脏压塞可导致致命后果。我们之前报道了使用经皮心包穿刺引流术联合控制抽取心包积液量（控制性心包引流 [CPD]）治疗急性主动脉夹层 A 型合并心脏压塞患者的优异结果，可稳定患者病情。本研究评估了该方法的早期和晚期结果。
2003 年 9 月至 2018 年 7 月，308 例急性主动脉夹层 A 型患者接受了手术治疗，其中 76 例入院时出现心脏压塞。49 例经静脉容量复苏治疗无效的患者在急诊室接受 CPD，其中 14 例（28.6%）出现心肺骤停。CPD 后 39 例（79.6%）患者被转至手术室立即进行主动脉修复。其余 10 例（20.4%）患者入院时接受了药物治疗，数天后进行了主动脉修复。
49 例患者 CPD 前平均收缩压为 64.4 ± 10.3mmHg。CPD 后所有患者的血压均显著升高。共抽取心包积液 46.8 ± 56.2mL，其中 30 例（61%）患者仅抽取 30mL 或更少的积液即可改善血压。所有患者均成功进行了主动脉修复。早期院内死亡率为 16%。但 CPD 无相关死亡率。平均随访时间为 52.9 ± 54.3 个月。5 年后累积生存率为 63.4%。
CPD 治疗急性主动脉夹层 A 型合并心脏压塞可获得满意的早期和晚期结果。
