Peng Qinbao, Cai Minjia, Chen Xing, Lin Tianxiao, Meng Weipeng, Guan Li, Zhu Peng, Zheng Shaoyi, Lu Jun, Zhou Pengyu
Department of Cardiovascular Surgery, Nanfang Hospital, Southern Medical University, Guangzhou, China.
De Feng Academy, Southern Medical University, Guangzhou, China.
J Thorac Dis. 2023 Sep 28;15(9):4859-4868. doi: 10.21037/jtd-23-561. Epub 2023 Aug 30.
Acute type A aortic dissection (ATAAD) is associated with high mortality. Previous studies found that maintaining a high level of oxygen delivery (DO) could decrease the postoperative mortality, but the minimum threshold of DO remained unclear. The present study aimed to investigate the relationship between maintaining intraoperative DO ≥280 mL/(min·m) and the 90-day postoperative mortality of ATAAD patients.
The clinical data of 178 ATAAD patients who underwent Sun's procedure in our center from January 2018 to July 2022 were retrospectively analyzed in the present cohort study. The included patients were divided into hypoxic group [DO <280 mL/(min·m)] and normoxic group [DO ≥280 mL/(min·m)]. The primary endpoint was the 90-day all-cause mortality, and the secondary endpoints were postoperative mechanical ventilation time, the application of continuous renal replacement therapy (CRRT), brain complications, and other postoperative complications.
Among all the patients, a total of 23 patients died 90 days postoperatively. Compared with the hypoxic group, blood flow, hematocrit (HCT), DO, and DO/VO ratio during cardiopulmonary bypass (CPB) were significantly higher, while the need for CRRT and the 90-day mortality were significantly lower in the normoxic group. The median follow-up time was 4 months. Kaplan-Meier curve indicated that the survival rate of ATAAD patients in the normoxic group was significantly higher. Univariate cox regression analysis demonstrated that 90-day mortality was reduced by 72.1% in the normoxic group.
Maintaining DO ≥280 mL/(min·m) during CPB by increasing CPB flow and HCT level is associated with decreased 90-day mortality of ATAAD patients.
急性A型主动脉夹层（ATAAD）与高死亡率相关。既往研究发现维持高水平的氧输送（DO）可降低术后死亡率，但DO的最低阈值仍不清楚。本研究旨在探讨维持术中DO≥280 mL/（min·m²）与ATAAD患者术后90天死亡率之间的关系。
在本队列研究中，回顾性分析了2018年1月至2022年7月在我院中心接受孙氏手术的178例ATAAD患者的临床资料。纳入患者分为低氧组[DO<280 mL/（min·m²）]和常氧组[DO≥280 mL/（min·m²）]。主要终点为90天全因死亡率，次要终点为术后机械通气时间、持续肾脏替代治疗（CRRT）的应用、脑部并发症及其他术后并发症。
所有患者中，共有23例患者术后90天死亡。与低氧组相比，常氧组体外循环（CPB）期间的血流量、血细胞比容（HCT）、DO及DO/VO₂比值显著更高，而CRRT需求和90天死亡率显著更低。中位随访时间为4个月。Kaplan-Meier曲线表明常氧组ATAAD患者的生存率显著更高。单因素Cox回归分析显示常氧组90天死亡率降低了72.1%。
通过增加CPB流量和HCT水平在CPB期间维持DO≥280 mL/（min·m²）与ATAAD患者90天死亡率降低相关。
