Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany -
Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany.
J Cardiovasc Surg (Torino). 2022 Dec;63(6):734-741. doi: 10.23736/S0021-9509.22.12339-6. Epub 2022 Aug 1.
In thoracic aortic surgery, fluid replacement and blood transfusion during extracorporeal circulation (ECC) are associated with increased coagulopathy, elevated inflammatory response, and end-organ dysfunction. The optimal strategy has not been established in this regard. The aim of this study was to evaluate the effect of the fluid balance during ECC in thoracic aortic dissection surgery on outcome.
Between 2009 and 2020, 358 patients suffering from acute type A aortic dissection (ATAAD) underwent aortic surgery at our heart center. In-hospital mortality, major complications (postoperative stroke, respiratory failure, heart failure, acute renal failure), and follow-up mortality were assessed. Logistic regression analysis was used to identify whether fluid balance and blood transfusion during ECC were risk factors for occurring adverse events.
The in-hospital mortality amounted to 20.4%. Major complications included temporary neurologic deficit in 13.4%, permanent neurologic deficit in 6.1%, acute renal failure in 32.7%, prolonged ventilation for respiratory failure in 17.9%, and acute heart failure in 10.9% of cases. At a mean of 42 months after discharge of 285 survivors, follow-up mortality was 13.3%. Multivariate analysis revealed major complications as well as the risk of in-hospital and follow-up mortality to increase with fluid balance and blood transfusion during ECC.
Fluid balance and blood transfusion during ECC present with predictive potential concerning the risk of postoperative adverse events.
在胸主动脉手术中，体外循环（ECC）期间的液体替代和输血与凝血功能障碍、炎症反应升高和终末器官功能障碍有关。在这方面，尚未确定最佳策略。本研究旨在评估 ECC 期间液体平衡对胸主动脉夹层手术结果的影响。
2009 年至 2020 年期间，358 例急性 A 型主动脉夹层（ATAAD）患者在我们的心脏中心接受了主动脉手术。评估住院死亡率、主要并发症（术后中风、呼吸衰竭、心力衰竭、急性肾衰竭）和随访死亡率。采用逻辑回归分析确定 ECC 期间的液体平衡和输血是否是发生不良事件的危险因素。
住院死亡率为 20.4%。主要并发症包括暂时性神经功能缺损 13.4%、永久性神经功能缺损 6.1%、急性肾衰竭 32.7%、因呼吸衰竭需要延长通气 17.9%和急性心力衰竭 10.9%。在 285 例幸存者出院后平均 42 个月的随访中，随访死亡率为 13.3%。多变量分析显示，主要并发症以及住院和随访死亡率的风险随着 ECC 期间的液体平衡和输血而增加。
ECC 期间的液体平衡和输血与术后不良事件的风险具有预测潜力。
