15年随访中急性A型主动脉夹层急诊修复术后不良临床结局的术前预测因素
Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up.
作者信息
Freundt Miriam, Kolat Philipp, Friedrich Christine, Salem Mohamed, Gruenewald Matthias, Elke Gunnar, Pühler Thomas, Cremer Jochen, Haneya Assad
机构信息
Department of Cardiovascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Arnold-Heller-Straße 3, 24105 Kiel, Germany.
Heart and Vascular Institute, Intensive Care Unit, Penn State Health Milton S. Hershey Medical Center, Hershey, PA 23538, USA.
出版信息
J Clin Med. 2021 Nov 18;10(22):5370. doi: 10.3390/jcm10225370.
BACKGROUND
Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management.
METHODS
We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy.
RESULTS
Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%.
CONCLUSIONS
This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.
背景
急性A型主动脉夹层（AAAD）死亡率很高。手术技术的改进降低了死亡率，但术后功能状态以及因功能障碍导致的生活质量下降仍然令人担忧。我们的研究旨在确定可预测不良结局的术前状况，以帮助指导围手术期管理。
方法
我们对2001年至2018年在本机构接受修复的394例AAAD患者进行了回顾性分析。将一组参数的综合终点定义为：（1）30天死亡率与住院死亡率；（2）新出现的神经功能缺损；（3）术后需要肾脏替代治疗的新出现的急性肾功能不全；（4）需要气管切开术的长时间机械通气。
结果
总生存率/随访时间平均为3.2年，随访完整性为94%。52.8%的患者达到终点。这些患者的欧洲心脏手术风险评估系统（EuroSCORE）II评分较高（7.5比5.5），冠状动脉疾病（CAD）发生率较高（9.2%比3.2%），就诊时神经功能缺损（ND）发生率较高（26.4%比11.8%），心肺复苏（CPR）发生率较高（14.4%比1.6%），术前插管率（RF）较高（16.9%比4.8%）。7天死亡率为21.6%比0%。住院死亡率为30.8%比0%。
结论
这项15年的随访表明，术后不良临床结局与就诊时的ND、CAD、CPR和RF有关。
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