Shetty Varun, Shetty Devi Prasad, Rao Parachuri Venkat, Hosabettu Praveen Kumar, Subramanian Sendur, Vikneswaran Gunaseelan, Narayan Pradeep
Department of Cardiothoracic Surgery, Narayana Institute of Cardiac Sciences, Bengaluru, Karnataka, India.
J Card Surg. 2022 Jun;37(6):1654-1660. doi: 10.1111/jocs.16401. Epub 2022 Mar 14.
Early repair is recommended in type A aortic dissection repair, however, this is not often possible. The aim of this study was to assess the time delays, examine the effect of timing and malperfusion on outcomes, and identify other independent risk factors for mortality.
This was a retrospective study on data collected prospectively. Primary outcome was 30-day mortality. Secondary outcome was adverse postoperative outcomes. All patients who arrived at the hospital with a type A aortic dissection, irrespective of the timing, were included in the study. Univariate as well as multivariate analysis was carried out.
A total of 81 patients presented to our institution during the study period. Half the patients got operated within 86 h of symptom onset and 75% were operated within 183 h. With regards to malperfusion, 6 (8.8%) patients had cerebral malperfusion, 10 (14.7%) had features of myocardial ischemia, and 13 (19.1%) had renal malperfusion. One (1.5%) patient had mesenteric ischemia and 9 (13.2%) had limb ischemia. The duration between symptom onset and operative repair was longer in survivors (152 ± 167 vs. 75 ± 102, p = .29). A total of 29 (42.6%) patients presented with features of one or more organ malperfusion and the mortality in these patients was significantly higher at 10 (34.5%) versus 5 (12.5%); p = .04. Multivariable logistic regression identified CPB time as an independent risk factor in our cohort for 30-day mortality (odds ratio: 1.03; 95% confidence interval: 1.007-1.06).
In cases of predominantly delayed presentation and operative repair, the outcome is significantly influenced by presence of malperfusion. Surgical repair still produces satisfactory outcomes and should be undertaken at the earliest in most cases.
A型主动脉夹层修复推荐早期修复，但这往往难以实现。本研究的目的是评估时间延迟，研究时机和灌注不良对预后的影响，并确定其他独立的死亡风险因素。
这是一项对前瞻性收集的数据进行的回顾性研究。主要结局是30天死亡率。次要结局是术后不良结局。所有因A型主动脉夹层入院的患者，无论时机如何，均纳入研究。进行了单因素和多因素分析。
在研究期间，共有81例患者就诊于我院。一半的患者在症状出现后86小时内接受手术，75%的患者在183小时内接受手术。关于灌注不良，6例（8.8%）患者出现脑灌注不良，10例（14.7%）有心肌缺血特征，13例（19.1%）有肾灌注不良。1例（1.5%）患者出现肠系膜缺血，9例（13.2%）有肢体缺血。幸存者症状出现至手术修复的时间更长（152±167 vs. 75±102，p = 0.29）。共有29例（42.6%）患者出现一个或多个器官灌注不良特征，这些患者的死亡率显著更高，为10例（34.5%），而无灌注不良患者为5例（12.5%）；p = 0.04。多变量逻辑回归确定体外循环时间是我们队列中30天死亡率的独立风险因素（比值比：1.03；95%置信区间：1.007 - 1.06）。
在主要为延迟就诊和手术修复的病例中，灌注不良的存在对预后有显著影响。手术修复仍能产生满意的结果，在大多数情况下应尽早进行。
