Tokyo CCU Network Scientific Committee, Tokyo, Japan.
Department of Cardiovascular Surgery, St. Luke's International Hospital, Tokyo, Japan.
Eur J Cardiothorac Surg. 2021 Oct 22;60(4):957-964. doi: 10.1093/ejcts/ezab146.
We investigated the various pre- and postoperative complications related to early (30-day) mortality after open surgery for acute type A aortic dissection.
Data from the Tokyo Acute Aortic Super-network database spanning January 2015 to December 2017 were retrospectively reviewed. Pre- and postoperative factors related to early postoperative mortality were assessed in 1504 of 2058 (73.0%) consecutive patients [age: 66.6 (SD: 13.5) years, male: 52.9%] who underwent acute type A aortic dissection repair.
The early mortality rate following surgical repair was 8.9%. According to multivariable analysis, male sex [odds ratio (OR) 1.670, 95% confidence interval (CI) 1.063-2.624, P = 0.026], use of percutaneous circulatory assist devices (n = 116, 7.7%) including extracorporeal membrane oxygenators or intra-aortic balloon pumps (OR 4.857, 95% CI 2.867-8.228, P < 0.001), shock (n = 162, 10.8%) (OR 3.06, 95% CI 1.741-5.387, P < 0.001), cardiopulmonary arrest (n = 41, 2.7%) (OR 7.534, 95% CI 3.407-16.661, P < 0.001), coronary ischaemia (n = 36, 2.3%) (OR 2.583, 95% CI 1.042-6.404, P = 0.041) and cerebral ischaemia (n = 59, 3.9%) (OR 2.904, 95% CI 1.347-6.261, P = 0.007) were independent preoperative risk factors for early mortality, while cardiac tamponade (n = 34, 2.3%) (OR 10.282, 95% CI 4.640-22.785, P < 0.001), cerebral ischaemia (n = 80, 5.3%) (OR 2.409, 95% CI 1.179-4.923, P = 0.016) and mesenteric ischaemia (n = 15, 1.0%) (OR 44.763, 95% CI 13.027-153.808, P < 0.001) were independent postoperative risk factors.
Not only critical preoperative conditions but also postoperative cardiac tamponade and vital organ ischaemia are risk factors for early mortality after acute type A aortic dissection repair.
我们研究了与急性 A 型主动脉夹层手术后 30 天内死亡率相关的各种术前和术后并发症。
回顾了 2015 年 1 月至 2017 年 12 月期间东京急性 A 型主动脉夹层超级网络数据库的数据，对 1504 名（73.0%）连续接受急性 A 型主动脉夹层修复手术的患者[年龄：66.6（标准差：13.5）岁，男性：52.9%]的术前和术后相关因素进行了评估。
手术修复后的早期死亡率为 8.9%。根据多变量分析，男性[比值比（OR）1.670，95%置信区间（CI）1.063-2.624，P=0.026]、使用经皮循环辅助设备（n=116，7.7%）包括体外膜肺氧合或主动脉内球囊泵（OR 4.857，95%CI 2.867-8.228，P<0.001）、休克（n=162，10.8%）（OR 3.06，95%CI 1.741-5.387，P<0.001）、心搏骤停（n=41，2.7%）（OR 7.534，95%CI 3.407-16.661，P<0.001）、冠状动脉缺血（n=36，2.3%）（OR 2.583，95%CI 1.042-6.404，P=0.041）和脑缺血（n=59，3.9%）（OR 2.904，95%CI 1.347-6.261，P=0.007）是早期死亡的独立术前危险因素，而心脏压塞（n=34，2.3%）（OR 10.282，95%CI 4.640-22.785，P<0.001）、脑缺血（n=80，5.3%）（OR 2.409，95%CI 1.179-4.923，P=0.016）和肠系膜缺血（n=15，1.0%）（OR 44.763，95%CI 13.027-153.808，P<0.001）是术后独立的危险因素。
不仅是危急的术前情况，而且术后心脏压塞和重要器官缺血也是急性 A 型主动脉夹层修复术后早期死亡的危险因素。
