Biancari Fausto, Dell'Aquila Angelo M, Onorati Francesco, Rossetti Cecilia, Demal Till, Rukosujew Andreas, Peterss Sven, Buech Joscha, Fiore Antonio, Folliguet Thierry, Perrotti Andrea, Hervé Amélie, Nappi Francesco, Conradi Lenard, Pinto Angel G, Lega Javier Rodriguez, Pol Marek, Kacer Petr, Wisniewski Konrad, Mazzaro Enzo, Gatti Giuseppe, Vendramin Igor, Piani Daniela, Ferrante Luisa, Rinaldi Mauro, Quintana Eduard, Pruna-Guillen Robert, Gerelli Sebastien, Di Perna Dario, Acharya Metesh, Mariscalco Giovanni, Field Mark, Kuduvalli Manoj, Pettinari Matteo, Rosato Stefano, Mustonen Caius, Kiviniemi Tuomas, Roberts Charles S, Mäkikallio Timo, Juvonen Tatu
Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland.
Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
Am J Cardiol. 2024 Apr 15;217:59-67. doi: 10.1016/j.amjcard.2024.01.035. Epub 2024 Feb 23.
Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
A型主动脉夹层（TAAD）手术与早期死亡的高风险相关。在这项多中心队列研究中，评估了一种新的手术紧急程度分类的预后影响。在多中心回顾性欧洲TAAD注册研究（ERTAAD）中，回顾性收集了连续接受急性TAAD手术患者的数据。3902例连续患者的院内死亡率随ERTAAD手术紧急程度分级增加：紧急手术为10.0%，急诊手术1级为13.3%，急诊手术2级为22.1%，挽救手术1级为45.6%，挽救手术2级为57.1%（p<0.0001）。术前动脉血乳酸与紧急程度分级相关。纳入ERTAAD手术紧急程度分类显著改善了回归模型的受试者操作特征曲线下面积、综合判别指数和净重新分类指数。术后中风/全脑缺血、肠系膜缺血、下肢缺血、透析和急性心力衰竭的风险随紧急程度分级增加。总之，急性TAAD手术修复的紧急程度似乎对院内死亡风险有显著影响，可能有助于改善这些危重症患者手术风险的分层。这项研究表明TAAD的挽救手术是合理的，因为一半的患者可能存活至出院。
