Department of Cardiovascular Surgery, Beijing Anzhen Hospital, Capital Medical University, and Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China.
J Int Med Res. 2020 Nov;48(11):300060520968450. doi: 10.1177/0300060520968450.
This study aimed to investigate the relationship between the duration of cardiopulmonary bypass (CPB) and stroke or early death in patients with acute type A aortic dissection (ATAAD) receiving total aortic arch replacement with the frozen elephant trunk procedure (TAR with FET).
A retrospective cohort study of 258 consecutive patients was conducted at Beijing Anzhen Hospital from December 2014 to June 2016. Patients who received TAR with FET for ATAAD were included. An adverse outcome (AO) was defined as 30-day mortality or stroke. Additionally, an AO was compared using propensity score matching.
The incidence of AO was 13.6% (n = 35). The 30-day mortality rate was 10.8% and the stroke rate was 9.3%. Patients were aged 47.9 ± 10.6 years old. The duration of CPB was an independent predictor of occurrence of AO after adjusting for confounding factors by multivariable logistic regression analysis (odds ratio 1.101, 95% confidence interval 1.003-1.208). In matched analysis, CPB duration remained a risk factor of AO.
The duration of CPB is an independent predictor of AO in surgical repair for ATAAD. The underlying mechanisms of this association are important for developing improved prevention strategies.
本研究旨在探讨在接受全主动脉弓置换加冷冻象鼻手术（TAR 加 FET）治疗急性 A 型主动脉夹层（ATAAD）的患者中，体外循环（CPB）时间与中风或早期死亡之间的关系。
对 2014 年 12 月至 2016 年 6 月期间在北京安贞医院进行的 258 例连续患者进行回顾性队列研究。纳入接受 TAR 加 FET 治疗 ATAAD 的患者。不良结局（AO）定义为 30 天死亡率或中风。此外，通过倾向评分匹配比较 AO。
AO 的发生率为 13.6%（n=35）。30 天死亡率为 10.8%，中风发生率为 9.3%。患者年龄为 47.9±10.6 岁。多变量逻辑回归分析调整混杂因素后，CPB 时间是发生 AO 的独立预测因素（优势比 1.101，95%置信区间 1.003-1.208）。在匹配分析中，CPB 时间仍然是 AO 的危险因素。
CPB 时间是 ATAAD 手术修复中 AO 的独立预测因素。这种关联的潜在机制对于制定改进的预防策略很重要。
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