Postoperative myocardial infarction in acute type A aortic dissection: A report from the International Registry of Acute Aortic Dissection
Postoperative myocardial infarction in acute type A aortic dissection: A report from the International Registry of Acute Aortic Dissection
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DOI：
10.1016/j.jtcvs.2016.10.064
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发表时间：
2017-03-01
影响因子：
6
通讯作者：
Khoynezhad, Ali
中科院分区：
文献类型：
--
作者：
Waterford, Stephen D.;Di Eusanio, Marco;Khoynezhad, Ali
目的：术后心肌梗死仍然是心脏手术的严重并发症。这种情况在急性 A 型主动脉夹层中的发生率和影响尚不清楚。 方法：1996 年至 2013 年国际急性主动脉夹层登记处共纳入 1445 例接受手术的急性 A 型主动脉夹层患者。排除术前入院时有心肌梗死且有心肌梗死病史的个体。将术后发生心肌梗死的患者 (n = 38, 2.6%) 与无术后心肌梗死的患者 (n = 1407, 97.4%) 进行比较。结果：术后心肌梗死组多为白种人 (100% vs 90%, P = .043)，并有二尖瓣主动脉瓣 (15.6% vs 4.5%, P = .015)。影像学显示更多的主动脉根部受累（75.8% vs 49.5%，P = .003）、心包积液（65.5% vs 44.1%，P = .022）和冠状动脉受损（27.3% vs 10.2%，P = .022）。术后心肌梗死患者在手术期间更容易发生低血压或休克（42.9% vs 25.5%，P = .021）。术后心肌梗死患者更有可能接受根部置换术（54.5% vs 33.3%，P = .011）、冠状动脉旁路移植术（28.6% vs 7.4%，P < .001）或主动脉瓣置换术（40.0% vs 23.8%，P = .027），并且不太可能接受完全弓置换术（2.8% vs 14.0%， P = .050)。术后心肌梗塞的中位停循环时间较长（60 分钟 vs 38 分钟，P = 0.024）。术后心肌梗死的院内死亡率（57.9% vs 16.3%，P < .001）和 Kaplan-Meier 估计的 5 年死亡率（P = .007）明显更高。 结论：术后心肌梗死是 A 型主动脉夹层修复术的破坏性并发症。它与二叶式主动脉瓣、根部受累、心包积液和手术修复程度相关。术后发生心肌梗死的患者较无术后心肌梗死的患者有更高的严重术后并发症、院内死亡率和5年死亡率。
Objective: Postoperative myocardial infarction remains a serious complication in cardiac surgery. The incidence and impact of this condition in acute type A aortic dissection are poorly understood.Methods: A total of 1445 patients with acute type A aortic dissection who underwent surgery were enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2013. Individuals with preoperative myocardial infarction at hospital presentation and a history of myocardial infarction were excluded. Patients with postoperative myocardial infarction (n = 38, 2.6%) were compared with those without postoperative myocardial infarction (n = 1407, 97.4%)Results: The postoperative myocardial infarction group was more often of white race (100% vs 90%, P = .043) with bicuspid aortic valve (15.6% vs 4.5%, P = .015). Imaging demonstrated more aortic root involvement (75.8% vs 49.5%, P = .003), pericardial effusion (65.5% vs 44.1%, P = .022), and coronary artery compromise (27.3% vs 10.2%, P = .022). Patients with postoperative myocardial infarction were more frequently hypotensive or in shock during surgery (42.9% vs 25.5%, P = .021). Patients with postoperative myocardial infarction were more likely to have undergone root replacement (54.5% vs 33.3%, P = .011), coronary artery bypass grafting (28.6% vs 7.4%, P < .001), or aortic valve replacement (40.0% vs 23.8%, P = .027), and less likely to have had complete arch replacement (2.8% vs 14.0%, P = .050). Median circulatory arrest time was higher in postoperative myocardial infarction (60 vs 38 minutes, P = .024). In-hospital mortality (57.9% vs 16.3%, P < .001) and Kaplan-Meier estimates of 5-year mortality (P = .007) were distinctly higher in postoperative myocardial infarction.Conclusions: Postoperative myocardial infarction is a devastating complication of type A aortic dissection repair. It is associated with bicuspid aortic valve, root involvement, pericardial effusion, and extent of surgical repair. Patients with postoperative myocardial infarction have higher serious postoperative complications, in-hospital mortality, and 5-year mortality rates than those without postoperative myocardial infarction.