Duan Lian, Zhang Chengliang, Chen Xuliang, Wang E, Ye Zhi, Duan Yanying, Huang Lingjin
Department of Cardiovascular Surgery, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
Department of Anesthesiology, National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha 410008, China.
J Pers Med. 2023 Aug 25;13(9):1296. doi: 10.3390/jpm13091296.
The optimal surgical strategy for acute type A aortic dissection (ATAAD) with coronary artery disease (CAD) remains unclear. The goal of this study was to investigate the cardiovascular protective effects of the myocardial priority (MP) strategy or traditional selective cerebral perfusion (SCP) in ATAAD with CAD. A total of 214 adults were analyzed retrospectively, of which 80 underwent the MP strategy intraoperatively. Seventy-nine pairs were propensity-score-matched and divided into SCP and MP groups. The follow-up period ranged from 6 to 36 months. The MP group had a significantly shorter myocardial ischemic time, higher perfusion flow, higher radial artery pressure, and lower incidence of NIRS decrease >20% of the base value, but a longer lower limb circulatory arrest and bypass time than the SCP group. Although similar adverse cardiac and cerebrovascular events were observed in both groups, a shorter posthospital stay, less blood loss and transfusion, higher postoperative hemoglobin, lower creatinine, and higher PaO/FiO were observed in the MP group. Subgroup analysis showed that when the TIMI Risk Score was <4, the MP group had a lower incidence of low cardiac output and lower postoperative cTnI level. The follow-up patients had similar morbidities between the two groups. The novel MP strategy is associated with a shortened myocardial ischemic time, better maintained perfusion of vital organs, and postoperative recovery after surgery for ATAAD combined with non-severe CAD.
急性A型主动脉夹层（ATAAD）合并冠状动脉疾病（CAD）的最佳手术策略仍不明确。本研究的目的是探讨心肌优先（MP）策略或传统选择性脑灌注（SCP）对ATAAD合并CAD患者的心血管保护作用。对214例成年人进行回顾性分析，其中80例术中采用MP策略。79对患者进行倾向评分匹配并分为SCP组和MP组。随访时间为6至36个月。与SCP组相比，MP组心肌缺血时间显著缩短，灌注流量更高，桡动脉压力更高，近红外光谱（NIRS）降低>基础值20%的发生率更低，但下肢循环阻断和体外循环时间更长。虽然两组观察到相似的不良心脑血管事件，但MP组住院时间更短，失血量和输血量更少，术后血红蛋白更高，肌酐更低，动脉血氧分压/吸入氧分数（PaO/FiO）更高。亚组分析显示，当心肌梗死溶栓治疗（TIMI）风险评分<4时，MP组低心输出量发生率更低，术后肌钙蛋白I（cTnI）水平更低。两组随访患者的发病率相似。新型MP策略与ATAAD合并非重度CAD手术后心肌缺血时间缩短、重要器官灌注更好维持及术后恢复相关。
