Zhao Rui, Qiu Juntao, Dai Lu, Song Jian, Fan Shuya, Cao Fangfang, Qiu Jiawei, Xu Zhiyun, Fan Ruixing, Guo Yingqiang, Gu Tianxiang, Jiang Xionggang, Li Decai, Qiao Chenhui, Chen Ziying, Song Bing, Yu Cuntao
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Department of Cardiothoracic Surgery, Changhai Hospital, Second Military Medical University, Shanghai, China.
JACC Asia. 2022 Nov 29;2(7):869-878. doi: 10.1016/j.jacasi.2022.08.009. eCollection 2022 Dec.
Many countries and regions have established multicenter registration studies to improve the outcomes of acute type A aortic dissection (ATAAD).
The aims of this study were to report actual preoperative management, surgery type, and early outcomes of surgical treatment for ATAAD in China.
This cohort study uses data from the China Registry of Type A Aortic Dissection, a national clinical registry to investigate management of patients with Stanford type A aortic dissection. The data, including surgical management and outcomes of patients with ATAAD, were analyzed from January 2018 to December 2021.
A total of 1,058 patients with ATAAD were enrolled in this study between January 2018 and December 2021. The mean age of all patients was 51.6 ±11.7 years. The median interval from onset to hospital was 10.65 hours (IQR: 6-24 hours), and the median interval from entering the emergency room to starting operation was 13 hours (IQR: 4.08-28.7 hours). Total arch repair was performed in 938 patients (88.7%), and frozen elephant trunk repair was performed in 800 patients (75.6%). The incidence of early mortality was 7.6%.
The population of patients with ATAAD in China experienced a longer interval from onset to arrival at the hospital, received more extensive aortic arch repair, and showed a relatively lower early mortality. These findings suggest that there may be a huge survivor bias in patients with ATAAD in China, more efforts should be made to promote prehospital emergency care and preoperative management of Chinese ATAAD patients. (A multicenter registration study of aortic dissection in China; ChiCTR1800015338).
许多国家和地区已开展多中心注册研究，以改善急性A型主动脉夹层（ATAAD）的治疗效果。
本研究旨在报告中国ATAAD患者术前的实际管理情况、手术类型及手术治疗的早期结果。
本队列研究使用了中国A型主动脉夹层注册研究的数据，这是一项全国性临床注册研究，旨在调查斯坦福A型主动脉夹层患者的管理情况。对2018年1月至2021年12月期间ATAAD患者的手术管理及结果数据进行了分析。
2018年1月至2021年12月期间，共有1058例ATAAD患者纳入本研究。所有患者的平均年龄为51.6±11.7岁。从发病到入院的中位间隔时间为10.65小时（四分位间距：6 - 24小时），从进入急诊室到开始手术的中位间隔时间为13小时（四分位间距：4.08 - 28.7小时）。938例患者（88.7%）进行了全主动脉弓修复，800例患者（75.6%）进行了冰冻象鼻手术。早期死亡率为7.6%。
中国ATAAD患者群体从发病到入院的间隔时间较长，接受了更广泛的主动脉弓修复，且早期死亡率相对较低。这些发现表明，中国ATAAD患者可能存在巨大的生存者偏差，应进一步努力促进中国ATAAD患者的院前急救和术前管理。（中国主动脉夹层多中心注册研究；ChiCTR1800015338）
