Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany; DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Lübeck, Kiel, Germany.
Department of Cardiac and Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.
Ann Thorac Surg. 2023 Sep;116(3):467-473. doi: 10.1016/j.athoracsur.2022.04.050. Epub 2022 May 17.
It is still controversial as to which cannulation strategy for acute type A aortic dissection (AAD) is optimal. Antegrade perfusion to diminish further organ malperfusion and ischemia is preferable.
We retrospectively analyzed a total of 420 patients who underwent AAD surgery from January 2001 to December 2020. Group A included 229 patients with a transatrial cannulation; group B included 191 patients with all other additionally used cannulation sites. A retrospective analysis was conducted at 30 days and according to clinical outcome and midterm mortality. Risk factors for probability of death were analyzed by multifactorial logistic regression.
The calculated risk scores and demographic preoperative variables were comparable except for hyperlipoproteinemia (P = .011) and redo operation in group B (P < .001) and more pericardial tamponade in group A (P = .006). In addition, fewer patients with postoperative new onset of renal failure were observed in group A (P = .039), although new onset of dialysis was not different between the groups (P = .878). Patients in group A were discharged from the hospital significantly earlier (P = .004). Nevertheless, although significantly more total arch surgery was performed in group A, shorter operation times (P < .001) and lower transfusion rates were observed in group A. Patients' follow-up after a median time of 3.6 (0.6-7.6) years showed no difference in 30-day, 1-year, and long-term mortality. Multivariate logistic regression revealed aortic valve stenosis (P = .041), coronary artery bypass graft surgical procedures (P = .014), preoperative cardiopulmonary resuscitation (P < .001), and length of surgery (P = .032) as the strongest risk factors for mortality.
Transatrial cannulation for AAD operation was safe and successfully performed under emergent conditions. Although no benefit in mortality was achieved, clinical benefits of shorter operation times, less transfusion, better kidney preservation, and earlier discharge of the patient were observed.
对于急性 A 型主动脉夹层（AAD），哪种插管策略最佳仍存在争议。顺行灌注以减少进一步的器官灌注不良和缺血是可取的。
我们回顾性分析了 2001 年 1 月至 2020 年 12 月期间接受 AAD 手术的 420 名患者。A 组包括 229 名经心房插管的患者；B 组包括 191 名使用其他附加插管部位的患者。在 30 天和根据临床结果和中期死亡率进行回顾性分析。通过多因素逻辑回归分析死亡概率的危险因素。
计算的风险评分和人口统计学术前变量除高脂血症（P=0.011）和 B 组再次手术（P<0.001）以及 A 组更多的心包填塞（P=0.006）外，无差异。此外，A 组术后新发肾衰竭患者较少（P=0.039），尽管两组之间新发透析无差异（P=0.878）。A 组患者出院时间明显更早（P=0.004）。尽管 A 组进行了更多的全弓手术，但 A 组的手术时间更短（P<0.001）且输血率更低。中位随访时间为 3.6（0.6-7.6）年后，两组患者在 30 天、1 年和长期死亡率方面无差异。多因素逻辑回归显示主动脉瓣狭窄（P=0.041）、冠状动脉旁路移植术（P=0.014）、术前心肺复苏（P<0.001）和手术时间（P=0.032）是死亡的最强危险因素。
经心房插管进行 AAD 手术是安全的，并可在紧急情况下成功进行。尽管在死亡率方面没有获益，但观察到手术时间更短、输血更少、肾脏保护更好以及患者更早出院的临床获益。
