Zhou Sangyu, Liu Yanxiang, Zhang Bowen, Wang Luchen, Zhao Ruojin, Xie Mingxin, Chen Xuyang, Dun Yaojun, Sun Xiaogang
Department of Cardiovascular Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Eur J Cardiothorac Surg. 2025 Feb 4;67(2). doi: 10.1093/ejcts/ezae385.
The goal was to report the outcomes and determine the effectiveness of a comprehensive organ protection strategy in total arch replacement.
A total of 350 patients who underwent total arch replacement were enrolled. Fifty-four patients underwent the comprehensive organ protection strategy with bilateral antegrade cerebral perfusion and the aortic balloon occlusion technique (comprehensive strategy group); 296 patients underwent the standard strategy with unilateral antegrade cerebral perfusion (standard strategy group). Inverse probability of treatment weighting was used to balance the baseline characteristics.
After inverse probability of treatment weighting, the comprehensive strategy group had lower incidences of 30-day mortality (0.9% vs 4.9%, P = 0.002), continuous renal replacement therapy (0.6% vs 10.3%, P < 0.001), renal failure (4.6% vs 13.7%, P < 0.001), hepatic dysfunction (11.6% vs 21.1%, P = 0.001) and shorter duration of mechanical ventilation [16 (13, 31) vs 20 (14, 48) h, P = 0.011]. Multivariable logistic analysis showed that the comprehensive strategy was an independent protective factor of 30-day mortality [odds ratio (OR): 0.242, 95% confidence interval (CI): 0.068-0.867, P = 0.029], continuous renal replacement therapy (OR: 0.045, 95% CI: 0.008-0.264, P = 0.001), renal failure (OR: 0.351, 95% CI: 0.156-0.788, P = 0.011) and mechanical ventilation >20 h (OR: 0.531, 95% CI: 0.319-0.883, P = 0.015). Kaplan-Meier analysis showed that mid-term survival was comparable.
The comprehensive organ protection strategy might improve early survival, reduce the use of continuous renal replacement therapy, have protective effects on the kidney and shorten mechanical ventilation time in total arch replacement. This strategy might be considered a viable alternative in total arch replacement.
本研究旨在报告全弓置换术中综合器官保护策略的结果，并确定其有效性。
共纳入350例行全弓置换术的患者。54例患者采用双侧顺行性脑灌注和主动脉球囊阻断技术的综合器官保护策略（综合策略组）；296例患者采用单侧顺行性脑灌注的标准策略（标准策略组）。采用治疗权重逆概率法平衡基线特征。
在进行治疗权重逆概率分析后，综合策略组的30天死亡率（0.9%对4.9%，P = 0.002）、持续肾脏替代治疗发生率（0.6%对10.3%，P < 0.001）、肾衰竭发生率（4.6%对13.7%，P < 0.001）、肝功能障碍发生率（11.6%对21.1%，P = 0.001）更低，机械通气时间更短[16（13，31）小时对20（14，48）小时，P = 0.011]。多变量逻辑回归分析显示，综合策略是30天死亡率[比值比（OR）：0.242，95%置信区间（CI）：0.068 - 0.867，P = 0.029]、持续肾脏替代治疗（OR：0.045，95% CI：0.008 - 0.264，P = 0.001）、肾衰竭（OR：0.351，95% CI：0.156 - 0.788，P = 0.011）和机械通气>20小时（OR：0.
