主动脉球囊阻断技术不能改善急性A型主动脉夹层伴下身灌注不良患者的围手术期结局。
Aortic Balloon Occlusion Technique Does Not Improve Peri-Operative Outcomes for Acute Type A Acute Aortic Dissection Patients With Lower Body Malperfusion.
作者信息
Tong Guang, Sun Zhongchan, Wu Jinlin, Zhao Shuang, Chen Zerui, Zhuang Donglin, Liu Yaorong, Yang Yongchao, Liang Zhichao, Fan Ruixin, Sun Tucheng
机构信息
Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, China.
Department of Cardiac Surgery, Ganzhou Municipal Hospital, Ganzhou, China.
出版信息
Front Cardiovasc Med. 2022 Mar 11;9:835896. doi: 10.3389/fcvm.2022.835896. eCollection 2022.
BACKGROUND
The management of malperfusion is vital to improve the outcomes of surgery for acute type A acute aortic dissection (ATAAD). Open arch repair under hypothermic circulatory arrest with selective antegrade cerebral perfusion (HCA/sACP) is safe and efficient but associated with inevitable hypothermia and ischemia-reperfusion injury. The aortic balloon occlusion (ABO) technique is shown to be organ protective by allowing higher temperature and shorter circulatory arrest time. In this study, we aimed to evaluate the safety and efficacy of this new technique for ATAAD patients with lower body malperfusion.
METHODS
Between January 2013 and November 2020, 355 ATAAD patients with lower body malperfusion who underwent arch repair in our institute were enrolled. The patients were divided into 2 groups: ABO group ( = 85) and HCA/sACP group ( = 271). Propensity score matching was performed to correct baseline differences.
RESULTS
Using the propensity score matching, 85 pairs were generated. Circulatory arrest time was significantly lower in the ABO group compared with the HCA/sACP group (median, 8 vs. 22 min; < 0.001). The incidence of in-hospital mortality (10.6 vs. 12.9%; = 0.812), stroke (7.1 vs. 7.1%; = 1.000), dialysis (25.9 vs. 32.9%; = 0.183), hepatic dysfunction (52.9 vs. 57.6%; = 0.537), tracheostomy (4.7 vs. 2.4%; = 0.682), paraplegia (1.2 vs. 4.7%; = 0.368) were comparable between ABO and HCA/sACP groups. Other outcomes and major adverse events were comparable. The multivariable logistic analysis did not recognize ABO technique protective against any major adverse outcomes.
CONCLUSIONS
For ATAAD patients with lower body malperfusion, the ABO technique allows the performance of arch repair with frozen elephant trunk (FET) under higher temperature and shorter circulatory arrest time. However, ABO technique did not improve perioperative outcomes. Future studies are warranted to evaluate the efficacy of this technique.
背景
急性A型主动脉夹层（ATAAD）手术中，对灌注不良的处理对于改善手术预后至关重要。在低温循环停搏下进行选择性顺行脑灌注（HCA/sACP）的开放弓部修复术安全有效，但不可避免地会导致体温过低和缺血再灌注损伤。主动脉球囊阻断（ABO）技术通过允许更高的体温和更短的循环停搏时间，显示出对器官具有保护作用。在本研究中，我们旨在评估这种新技术对伴有下半身灌注不良的ATAAD患者的安全性和有效性。
方法
2013年1月至2020年11月期间，纳入我院355例接受弓部修复术的伴有下半身灌注不良的ATAAD患者。将患者分为2组：ABO组（n = 85）和HCA/sACP组（n = 271）。进行倾向评分匹配以校正基线差异。
结果
通过倾向评分匹配，生成了85对匹配病例。ABO组的循环停搏时间显著低于HCA/sACP组（中位数，8分钟对22分钟；P < 0.001）。ABO组和HCA/sACP组的住院死亡率（10.6%对12.9%；P = 0.812）、卒中（7.1%对7.1%；P = 1.000）、透析（25.9%对32.9%；P = 0.183）、肝功能障碍（52.9%对57.6%；P = 0.537）、气管切开术（4.7%对2.4%；P = 0.682）、截瘫（1.2%对4.7%；P = 0.368）发生率相当。其他结局和主要不良事件也相当。多变量逻辑分析未发现ABO技术对任何主要不良结局具有保护作用。
结论
对于伴有下半身灌注不良的ATAAD患者，ABO技术可在更高体温和更短循环停搏时间下进行带冻结象鼻（FET）的弓部修复术。然而，ABO技术并未改善围手术期结局。未来有必要开展研究评估该技术的有效性。
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