Department of Cardiothoracic, Transplant and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Minneapolis Heart Institute, Abbott Northwestern Hospital, United States of America.
Perfusion. 2024 May;39(4):733-742. doi: 10.1177/02676591231157545. Epub 2023 Feb 16.
Acute type A aortic dissection (ATAAD) is one of the most critical emergencies in cardiovascular surgery. Additional complications such as organ malperfusion can significantly decrease the chances of survival. Despite promptly performed surgical treatment, impaired organ perfusion may persist, thus close postoperative monitoring is recommended. But, is there a surgical consequence due to the existence of a preoperatively known malperfusion and is there a correlation between pre-, peri- and postoperative levels of serum lactate and proven malperfusion?
Between 2011 and 2018, 200 patients (66% male; median age: 62.5 years; interquartile range: +/-12.4 years) that received surgical treatment at our institution for an acute dissection DeBakey type I were enrolled in this study. The cohort was divided into two groups according to the preoperative existence of malperfusion and non-malperfusion. At least one kind of malperfusion occurred in 74 patients (Group A: 37%), while 126 patients (Group B: 63%) showed no evidence of malperfusion. Furthermore, lactate levels of both cohorts were differentiated into four periods: preoperative, intraoperative, 24 hours after surgery, and 2-4 days after surgery.
The patients' status differed significantly prior to surgery. Group A (malperfusion) showed an elevated requirement for mechanical resuscitation (A: 10.8%; B: 5.6%; : 0.173), were significantly more often admitted in an intubated state (A: 14.9%; B: 2.4%; : 0.001) and showed higher incidences of stroke (A: 18.9% ( = 149); B: 3.2% ( = 4); : 0.001). Levels of serum lactate from the preoperative period until days 2-4 were significantly increased in the malperfusion cohort at all times.
Preexisting malperfusion due to ATAAD may significantly increase the chance of early mortality in patients with ATAAD. Serum lactate levels were a reliable marker for inadequate perfusion from admission until day 4 after surgery. Despite this, early intervention survival in this cohort remains limited.
急性A型主动脉夹层（ATAAD）是心血管外科学中最危急的情况之一。器官灌注不良等其他并发症会显著降低患者的存活率。尽管及时进行了外科治疗，但器官灌注不良可能持续存在，因此建议密切监测术后情况。但是，术前已知的灌注不良是否会导致手术结果出现问题，以及术前、术中和术后血清乳酸水平与证实的灌注不良之间是否存在相关性？
在 2011 年至 2018 年间，我院共收治了 200 名接受急性夹层 DeBakey Ⅰ型手术治疗的患者（66%为男性；中位年龄：62.5 岁；四分位距： +/-12.4 岁）。该队列根据术前是否存在灌注不良分为两组：灌注不良组（74 例，37%）和无灌注不良组（126 例，63%）。至少有一种灌注不良发生在 74 例患者中（灌注不良组 A：37%），而 126 例患者（灌注不良组 B：63%）没有灌注不良的证据。此外，两组患者的乳酸水平分为四个时期：术前、术中、术后 24 小时和术后 2-4 天。
两组患者术前情况存在显著差异。灌注不良组（灌注不良）需要机械复苏的比例较高（A：10.8%；B：5.6%；: 0.173），气管插管的比例显著较高（A：14.9%；B：2.4%；: 0.001），且卒中发生率较高（A：18.9%（ = 149）；B：3.2%（ = 4）；: 0.001）。灌注不良组的血清乳酸水平从术前到术后 2-4 天一直在升高。
ATAAD 引起的术前灌注不良可能显著增加 ATAAD 患者的早期死亡率。血清乳酸水平是从入院到术后第 4 天灌注不良的可靠标志物。尽管如此，该队列的早期干预生存率仍然有限。
