Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Prof. Dr. C.C. Iliescu Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania.
Medicina (Kaunas). 2023 Dec 23;60(1):27. doi: 10.3390/medicina60010027.
: Postoperative neurological complications (NCs) are an important cause of mortality in patients with acute type A aortic dissection (ATAAD). The aim of the study was to determine the association between intraoperative risk factors and newly developed postoperative NCs in patients after emergency surgery for ATAAD. : A total of 203 patients requiring emergency surgery were included in the study. Patients with preoperative neurological dysfunction, deceased on the operating table or within the first 48 h after intensive care admission, with uncertain postoperative neurologic status or with incomplete records were excluded. : Mean age was 57.61 ± 12.27 years. Hyperlipidemia was the most frequent comorbidity (69%). A bicuspid aortic valve was present in 12.8% of cases, severe acute aortic regurgitation was present in 29.1% of patients, and cardiac tamponade was present in 27.1% of cases. The innominate artery was the most frequently dissected supra-aortic artery in 27.1% of cases. In 65% of cases, the primary entry tear was at the level of the ascending aorta. The incidence of newly developed postoperative NCs was 39.4%. The most common surgical technique performed was supra-coronary ascending aorta and hemiarch replacement, in 53.2% of patients. Using logistic regression, cardiopulmonary bypass time (OR = 1.01; 95% CI = 1.01-1.02; < 0.001), aortic cross-clamp time over 3 h (OR = 2.71, 95% CI = 1.43-5.14, = 0.002) and cerebral perfusion time (OR = 1.02; 95% CI = 1.002-1.03; = 0.027) were independently associated with newly developed postoperative NCs. : Based on the results of the study, all efforts should be made to reduce operative times. Using a simple surgical technique, like the supra-coronary ascending aorta and hemiarch technique, whenever possible, and using a simpler technique for cerebral perfusion like unilateral cerebral perfusion via the right axillary artery, could reduce operating times.
术后神经系统并发症（NCs）是急性 A 型主动脉夹层（ATAAD）患者死亡的一个重要原因。本研究旨在确定接受紧急手术治疗的 ATAAD 患者术中危险因素与新出现的术后 NCs 之间的关系。
共有 203 名需要紧急手术的患者纳入本研究。排除术前神经功能障碍、手术台上死亡或重症监护入院后 48 小时内死亡、术后神经状态不确定或记录不完整的患者。
患者的平均年龄为 57.61 ± 12.27 岁。最常见的合并症是高脂血症（69%）。主动脉瓣二瓣化畸形见于 12.8%的病例，严重急性主动脉瓣反流见于 29.1%的患者，心脏压塞见于 27.1%的病例。无名动脉是最常发生夹层的升主动脉以上的主动脉，占 27.1%。在 65%的病例中，原发撕裂位于升主动脉水平。新出现的术后 NCs 的发生率为 39.4%。最常见的手术技术是冠状动脉以上升主动脉和半弓置换，占 53.2%的患者。使用逻辑回归，体外循环时间（OR=1.01；95%CI=1.01-1.02； < 0.001）、主动脉阻断时间超过 3 小时（OR=2.71；95%CI=1.43-5.14； = 0.002）和脑灌注时间（OR=1.02；95%CI=1.002-1.03； = 0.027）与新出现的术后 NCs 独立相关。
基于研究结果，应尽一切努力减少手术时间。尽可能使用简单的手术技术，如冠状动脉以上升主动脉和半弓技术，以及使用单侧经右腋动脉脑灌注等更简单的脑灌注技术，可减少手术时间。
