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透析患者急性 A 型主动脉夹层的手术治疗效果:单中心经验教训。

Surgical outcomes of acute type A aortic dissection in dialysis patients: lessons learned from a single-center's experience.

机构信息

Department of Cardio-Thoracic Surgery, Affiliated Drum Tower Hospital, Medical School of Nanjing University, Zhongshan Road 321, Nanjing, 210008, China.

Department of General Practice, Nanjing First Hospital, Nanjing Medical University, Nanjing, China.

出版信息

Sci Rep. 2022 Mar 30;12(1):5372. doi: 10.1038/s41598-022-09448-7.

Abstract

There is a paucity of data describing the safety and efficacy of acute type A aortic dissection (ATAAD) repair surgeries in dialysis patients. Our study aimed to investigated the influence of dialysis on early and late outcomes in end-stage renal disease (ESRD) patients who received repair surgery for ATAAD. A total of 882 ATAAD patients who received emergency aortic dissection repair at our center from January 2015 to December 2019 were retrospectively screened in this study and divided into the dialysis group (n = 16) and the non-dialysis group (n = 866), depending on whether they required dialysis for preoperative ESRD. No significant difference of age, preoperative hemodynamics, organ ischemia conditions, operative variables as well as the 30-Day mortality and in-hospital complications was discovered between two groups. However, the survival rates and the proportion of late aortic event (sudden death and reoperation) free population at 1 and 3 years after surgery were significantly decreased in dialysis patients compared to non-dialysis patients. Our study indicated that the short-term surgical outcomes of ATAAD in dialysis patients were comparable to non-dialysis patient. However, the dialysis patients were associated with a worse long-term prognosis.

摘要

关于透析患者接受急性 A 型主动脉夹层(ATAAD)修复手术的安全性和疗效的数据很少。我们的研究旨在探讨透析对接受 ATAAD 修复手术的终末期肾病(ESRD)患者早期和晚期结局的影响。本研究回顾性筛选了 2015 年 1 月至 2019 年 12 月在我院接受急诊主动脉夹层修复的 882 例 ATAAD 患者,根据术前 ESRD 是否需要透析将其分为透析组(n=16)和非透析组(n=866)。两组患者的年龄、术前血流动力学、器官缺血情况、手术变量以及 30 天死亡率和住院并发症无显著差异。然而,与非透析患者相比,透析患者术后 1 年和 3 年的生存率和晚期主动脉事件(猝死和再次手术)无事件人群比例明显降低。本研究表明,透析患者 ATAAD 的短期手术结果与非透析患者相当。然而,透析患者的长期预后较差。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/c158/8967816/63f5de8900ae/41598_2022_9448_Fig1_HTML.jpg

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