Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience
Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience
复制标题
DOI：
10.1016/j.jtcvs.2004.09.005
复制
发表时间：
2005-01-01
影响因子：
6
通讯作者：
Eagle, KA
中科院分区：
文献类型：
--
作者：
Trimarchi, S;Nienaber, CA;Eagle, KA
背景资料：根据单中心或外科医生的不同经验，急性A型主动脉夹层的手术死亡率从7%到30%不等。国际急性主动脉夹层登记处收集了来自全球18个转诊中心的患者，确定了当前急性A型主动脉夹层的术前风险分层方案和真实的平均手术死亡率。方法：在国际登记研究中，对1032例患者中的526例患者的290个临床变量及其与手术结局的关系进行了全面分析。1996年至2001年的急性主动脉夹层。根据风险特征分类的提取病例定义为不稳定（I组），存在心包填塞;休克;充血性心力衰竭;脑血管意外;卒中;昏迷;心肌缺血、梗死或两者兼有;心电图出现新的Q波或ST段抬高;急性肾衰竭;或手术时肠系膜缺血-梗死。不稳定的条件外，患者被归类为稳定（组II）。结果：总的住院死亡率为25.1%。I组的死亡率为31.4%，而II组为16.7%（P <0.001）。术前主动脉瓣置换术史是手术死亡率的独立预测因素（比值比= 3.12），迁移性胸痛（比值比= 2.77），低血压是急性A型主动脉夹层的体征（比值比= 1.95），休克或填塞（比值比= 2.69），术前心包填塞（比值比= 2.22），术前肢体缺血（优势比2.10）。结论：国际急性主动脉夹层登记处的经验证实，患者的选择在决定急性A型患者的手术结局方面起着重要作用主动脉夹层了解手术死亡率的重要危险因素有助于更好地管理急性A型主动脉夹层患者，并对其进行更明确的风险评估。
Background: Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era.Methods: A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II).Results: The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II (P < .001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio 2.10).Conclusions: The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.