Robu Mircea, Radulescu Bogdan, Margarint Irina Maria, Robu Cornel, Stiru Ovidiu, Iosifescu Andrei, Preda Silvia, Cacoveanu Mihai, Voica Cristian, Iliescu Vlad Anton, Moldovan Horatiu
Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania.
Emergency Institute for Cardiovascular Diseases "Prof. Dr. Iliescu", 022322 Bucharest, Romania.
Medicina (Kaunas). 2024 Apr 19;60(4):661. doi: 10.3390/medicina60040661.
The relationship between cerebral perfusion and new postoperative ischemic stroke in obese patients is not well defined. The aim of this study was to investigate the association between selective bilateral anterograde cerebral perfusion and new postoperative ischemic stroke in obese patients with emergency surgery for acute type A aortic dissection. A total of 292 patients with emergency surgery for acute type A aortic dissection were included in this study. Patients with hemorrhagic stroke or ischemic stroke with severe neurological dysfunction at admission that were not candidates for surgery; patients who died in the first 48 h after intensive care admission and patients with incomplete medical records were excluded. The mean age was 59.42 ± 10.68 years and the mean Euroscore was 9.12 ± 1.63. Obesity was present in 76.4%, the incidence of new postoperative ischemic stroke was 27.5%, and the postoperative mortality rate was 26.7%. The mean cardiopulmonary bypass time was 206.81 ± 75.48 min, the aortic cross-clamp time was 118.2 ± 46.42 min, and 90% of cases required cerebral perfusion. The mean cerebral perfusion time was 30.8 ± 24.41 min. Obese patients had a higher frequency of in-hospital death ( = 0.009), smoking ( = 0.036), hypertension ( = 0.023), left common carotid artery dissection ( < 0.001), right common carotid artery dissection ( = 0.029), femoral artery cannulation ( = 0.026), aortic root replacement ( = 0.009), aortic valve replacement ( = 0.005) and early reintervention for bleeding ( = 0.004). Using logistic regression, selective bilateral anterograde cerebral perfusion over 40 min in obese patients was independently associated with new postoperative ischemic stroke (OR = 2.35; 95%CI = 1.36-4.86; = 0.021). A patient-tailored strategy for cerebral perfusion should be considered in obese patients, considering the high atheromatous burden of the supra-aortic vessels in these patients and the potential risk of atheromatous embolization associated with this technique.
肥胖患者脑灌注与术后新发缺血性卒中之间的关系尚不明确。本研究的目的是调查在接受急诊A型主动脉夹层手术的肥胖患者中，选择性双侧顺行性脑灌注与术后新发缺血性卒中之间的关联。本研究共纳入292例接受急诊A型主动脉夹层手术的患者。排除入院时患有出血性卒中或伴有严重神经功能障碍的缺血性卒中且不适合手术的患者；重症监护入院后48小时内死亡的患者以及病历不完整的患者。平均年龄为59.42±10.68岁，平均欧洲心脏手术风险评估系统（Euroscore）评分为9.12±1.63。肥胖患者占76.4%，术后新发缺血性卒中的发生率为27.5%，术后死亡率为26.7%。平均体外循环时间为206.81±75.48分钟，主动脉阻断时间为118.2±46.42分钟，90%的病例需要脑灌注。平均脑灌注时间为30.8±24.41分钟。肥胖患者院内死亡（P=0.009）、吸烟（P=0.036）、高血压（P=0.023）、左颈总动脉夹层（P<0.001）、右颈总动脉夹层（P=0.029）、股动脉插管（P=0.026）、主动脉根部置换（P=0.009）、主动脉瓣置换（P=0.005）及早期出血再次干预（P=0.004）的发生率更高。采用逻辑回归分析，肥胖患者选择性双侧顺行性脑灌注超过40分钟与术后新发缺血性卒中独立相关（比值比[OR]=2.35；95%置信区间[CI]=1.36 - 4.86；P=0.021）。鉴于这些患者主动脉弓上血管的动脉粥样硬化负担较高以及该技术相关的动脉粥样硬化栓塞潜在风险，对于肥胖患者应考虑采用个体化的脑灌注策略。
