Department of Cardiovascular Surgery, Heart Centre Freiburg University, Faculty of Medicine, University of Freiburg, 79106 Freiburg, Germany.
Medicina (Kaunas). 2023 Oct 13;59(10):1825. doi: 10.3390/medicina59101825.
: The aim of this study was to analyze the influence of mass transfusion on the postoperative outcome and survival in patients presenting with acute Type A aortic dissection. : Between 2002 and 2020, a total of 505 patients were surgically treated for an acute Type A aortic dissection. Mass transfusion was defined as the peri- and postoperative replacement by transfusion of 10 units. Patient characteristics and outcomes were analyzed and compared between patients with and without mass transfusion. : Mass transfusion occurred in 105 patients (20%). The incidences of symptomatic coronary malperfusion ( = 0.017) and tamponade ( = 0.043) were higher in patients with mass transfusion. There was no statistically significant difference in the distal extension of the aortic dissection between the two groups. A valved conduit was significantly more common in patients with mass transfusion ( = 0.007), while the distal aortic repair was similar between the two groups. Cardiopulmonary bypass time ( < 0.001), cross clamp time ( < 0.001) and in-hospital mortality were significantly higher in patients with mass transfusion ( < 0.001), but the survival after discharge (landmark-analysis) showed equal survival between patients with and without mass transfusion (log rank: = 0.4). Mass transfusion was predictive of in-hospital mortality (OR: 3.308, < 0.001) but not for survival after discharge (OR: 1.205, = 0.661). : Mass transfusion is necessary in many patients with acute Type A aortic dissection. These patients present sicker and require longer surgery. However, mass transfusion does not influence survival after discharge.
: 本研究旨在分析大量输血对急性 A 型主动脉夹层患者术后转归和生存的影响。 : 2002 年至 2020 年间，共有 505 例急性 A 型主动脉夹层患者接受了手术治疗。大量输血定义为围手术期通过输血置换 10 个单位。分析和比较了输血患者和未输血患者的患者特征和结局。 : 105 例（20%）患者发生大量输血。输血患者症状性冠状动脉灌注不良（ = 0.017）和心脏压塞（ = 0.043）的发生率更高。两组患者的主动脉夹层远端延伸无统计学差异。输血患者中使用带瓣管道的情况更为常见（ = 0.007），而两组患者的远端主动脉修复情况相似。输血患者体外循环时间（ < 0.001）、主动脉阻断时间（ < 0.001）和住院死亡率显著更高（ < 0.001），但出院后（里程碑分析）的生存率在输血患者和未输血患者之间无差异（对数秩检验： = 0.4）。大量输血是住院死亡率的预测因素（OR：3.308， < 0.001），但不是出院后生存率的预测因素（OR：1.205， = 0.661）。 : 大量输血在许多急性 A 型主动脉夹层患者中是必要的。这些患者病情更重，需要更长的手术时间。然而，大量输血并不影响出院后的生存。
