急性A型主动脉夹层患者全弓手术后院内死亡的危险因素。

Risk factors for in-hospital mortality after total arch procedure in patients with acute type A aortic dissection.

作者信息

An Zhao, Zhong Keng, Sun Yangyong, Han Lin, Xu Zhiyun, Li Bailing

机构信息

Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University School of Medicine, Shanghai, China.

Department of Cardiovascular Surgery, Changhai Hospital, Naval Medical University, Shanghai, China.

出版信息

Front Cardiovasc Med. 2023 Apr 25;10:1149907. doi: 10.3389/fcvm.2023.1149907. eCollection 2023.

DOI:10.3389/fcvm.2023.1149907

PMID:37180796

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10167004/

Abstract

OBJECT

Knowledge about the risk factors of in-hospital mortality for acute type A aortic dissection (ATAAD) patients who received total arch procedure is limited. This study aims to investigate preoperative and intraoperative risk factors of in-hospital mortality of these patients.

METHODS

From May 2014 to June 2018, 372 ATAAD patients received the total arch procedure in our institution. These patients were divided into survival and death groups, and patients` in-hospital data were retrospectively collected. Receiver operating characteristic curve analysis was adopted to determine the optimal cut-off value of continuous variables. Univariate and multivariable logistic regression analyses were used to detect independent risk factors for in-hospital mortality.

RESULTS

A total of 321 patients were included in the survival group and 51 in the death group. Preoperative details showed that patients in the death group were older (55.4 ± 11.7 vs. 49.3 ± 12.6, = 0.001), had more renal dysfunction (29.4% vs. 10.9%, = 0.001) and coronary ostia dissection (29.4% vs. 12.2%, = 0.001), and decreased left ventricular ejection fraction (LVEF) (57.5 ± 7.9% vs. 59.8 ± 7.3%, = 0.032). Intraoperative results showed that more patients in the death group experienced concomitant coronary artery bypass grafting (35.3% vs. 15.3%, = 0.001) with increased cardiopulmonary bypass (CPB) time (165.7 ± 39.0 vs. 149.4 ± 35.8 min, = 0.003), cross-clamp time (98.4 ± 24.5 vs. 90.2 ± 26.9 min, = 0.044), and red blood cell transfusion (913.7 ± 629.0 vs. 709.7 ± 686.6 ml, = 0.047). Logistic regression analysis showed that age >55 years, renal dysfunction, CPB time >144 min, and RBC transfusion >1,300 ml were independent risk factors for in-hospital mortality in patients with ATAAD.

CONCLUSION

In the present study, we identified that older age, preoperative renal dysfunction, long CPB time, and intraoperative massive transfusion were risk factors for in-hospital mortality in ATAAD patients with the total arch procedure.

摘要

目的

对于接受全主动脉弓置换术的急性A型主动脉夹层（ATAAD）患者，关于其院内死亡风险因素的了解有限。本研究旨在调查这些患者术前和术中的院内死亡风险因素。

方法

2014年5月至2018年6月，372例ATAAD患者在我院接受了全主动脉弓置换术。这些患者被分为生存组和死亡组，并回顾性收集患者的院内数据。采用受试者工作特征曲线分析来确定连续变量的最佳截断值。单因素和多因素逻辑回归分析用于检测院内死亡的独立风险因素。

结果

生存组共纳入321例患者，死亡组51例。术前详细情况显示，死亡组患者年龄更大（55.4±11.7岁 vs. 49.3±12.6岁，P = 0.001），肾功能不全更多（29.4% vs. 10.9%，P = 0.001），冠状动脉开口夹层更多（29.4% vs. 12.2%，P = 0.001），左心室射血分数（LVEF）降低（57.5±7.9% vs. 59.8±7.3%，P = 0.032）。术中结果显示，死亡组更多患者同时接受冠状动脉旁路移植术（35.3% vs. 15.3%，P = 0.001），体外循环（CPB）时间增加（165.7±39.0分钟 vs. 149.4±35.8分钟，P = 0.003），主动脉阻断时间（98.4±24.5分钟 vs. 90.2±26.9分钟，P = 0.044），以及红细胞输注量（913.7±629.0毫升 vs. 709.7±686.6毫升，P = 0.047）。逻辑回归分析显示，年龄>55岁、肾功能不全、CPB时间>144分钟和红细胞输注量>1300毫升是ATAAD患者院内死亡的独立风险因素。