Yuan Hongliang, Sun Zhenxing, Zhang Yongxing, Wu Wenqian, Liu Manwei, Yang Yali, Wang Jing, Lv Qing, Zhang Li, Li Yuman, Xie Mingxing
Department of Ultrasound Medicine, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Hubei Province Key Laboratory of Molecular Imaging, Wuhan, China.
Front Cardiovasc Med. 2021 Nov 4;8:728568. doi: 10.3389/fcvm.2021.728568. eCollection 2021.
Acute type A aortic dissection (ATAAD) is a fatal condition that requires emergency surgery. The aim of the present study was to determine pre- and intra-operative risk factors for in-hospital mortality in patients with ATAAD. Consecutive 313 patients with ATAAD who underwent emergency surgery at our hospital from February 2012 to February 2017 were enrolled in our study. Univariate and multivariate logistic regression analysis were performed to identify the pre-operative and intra-operative risk factors for in-hospital mortality. Of the 313 patients, 32 patients (10.2%) died. Compared with survivors, non-survivors had higher heart rate, serum potassium level and EuroSCORE II, and higher incidence of moderate to severe pericardial effusion, supra-aortic vessels involvement, myocardial ischemia and lower-extremity ischemia. As for surgery-related factors, the duration of surgery and cardiopulmonary bypass time were longer in non-survivors than survivors. In addition, non-survivors were more likely to undergo coronary-artery bypass graft compared with survivors. On multivariate analysis, elevated plasma potassium level (OR: 43.0, 95% CI: 3.8-51.5, < 0.001), high incidence of supra-aortic vessels involvement (OR: 4.4, 95% CI: 1.5-7.0, = 0.008) and lower-extremity ischemia (OR: 4.9, 95% CI: 1.6-6.9; = 0.009), and longer duration of surgery (OR 6.0, 95% CI: 1.8-18.7, = 0.000) and cardiopulmonary bypass time (OR: 3.7, 95% CI: 1.3-9.3, = 0.001) were independently predictive of higher mortality in patients with ATAAD. Supra-aortic vessels involvement, lower-extremity ischemia and elevated plasma potassium level are independent predictors of mortality in patients with ATAAD. A significant decrease in duration of surgery and cardiopulmonary bypass time is helpful to improve survival of patients.
急性A型主动脉夹层（ATAAD）是一种需要紧急手术的致命疾病。本研究的目的是确定ATAAD患者院内死亡的术前和术中危险因素。2012年2月至2017年2月在我院接受紧急手术的313例连续ATAAD患者纳入本研究。进行单因素和多因素逻辑回归分析以确定院内死亡的术前和术中危险因素。313例患者中，32例（10.2%）死亡。与幸存者相比，非幸存者心率、血清钾水平和欧洲心脏手术风险评估系统（EuroSCORE）II更高，中重度心包积液、主动脉弓上血管受累、心肌缺血和下肢缺血的发生率更高。至于手术相关因素，非幸存者的手术时间和体外循环时间比幸存者更长。此外，与幸存者相比，非幸存者更有可能接受冠状动脉搭桥术。多因素分析显示，血浆钾水平升高（比值比：43.0，95%可信区间：3.8 - 51.5，P < 0.001）、主动脉弓上血管受累发生率高（比值比：4.4，95%可信区间：1.5 - 7.0，P = 0.008）和下肢缺血（比值比：4.9，95%可信区间：1.6 - 6.9；P = 0.009），以及手术时间延长（比值比6.0，95%可信区间：1.8 - 18.7，P = 0.000）和体外循环时间（比值比：3.7，95%可信区间：1.3 - 9.3，P = 0.001）是ATAAD患者死亡率升高的独立预测因素。主动脉弓上血管受累、下肢缺血和血浆钾水平升高是ATAAD患者死亡的独立预测因素。手术时间和体外循环时间的显著缩短有助于提高患者的生存率。
