Utility of the Penn Classification in Predicting Outcomes of Surgery for Acute Type A Aortic Dissection
Utility of the Penn Classification in Predicting Outcomes of Surgery for Acute Type A Aortic Dissection
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DOI：
10.1016/j.amjcard.2013.11.017
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发表时间：
2014-02-15
影响因子：
2.8
通讯作者：
Adachi, Hideo
中科院分区：
文献类型：
--
作者：
Kimura, Naoyuki;Ohnuma, Tetsu;Adachi, Hideo
Penn分级是一种急性A型主动脉夹层（AAAD）的风险评估系统，基于术前缺血状况。我们调查了Penn分级是否能预测AAAD手术后的结果。1997年1月至2011年1月，351例DeBakey I型AAAD患者接受手术治疗，根据Penn分类分为4组：Aa（无缺血，n = 187）、Ab（局部缺血伴分支灌注不良，n = 67）、Ac（全身缺血伴循环衰竭，n = 46）和Abc（局部和全身缺血，n = 51）。比较两组的早期和晚期结局。Penn Aa的住院死亡率为3%（6/187），Penn Ab为6%（4/67），Penn Ac为17%（8/46），Penn Abc为22%（11/51）。多因素Logistic回归分析显示，Penn分级Ac和Abc、手术时间>6小时、进入胸降主动脉是院内死亡的危险因素。两组之间神经系统、呼吸系统和肝脏并发症的发生率不同。Penn Aa组的5年累积生存率为85%，Penn Ab组为74%（p = 0.027 vs Penn Aa），Penn Ac组为78%，Penn Abc组为67%（p
The Penn classification, a risk assessment system for acute type A aortic dissection (AAAD), is based on preoperative ischemic conditions. We investigated whether Penn classes predict outcomes after surgery for AAAD. Three hundred fifty-one patients with DeBakey type I AAAD treated surgically, January 1997 to January 2011, were divided into 4 groups per Penn class: Aa (no ischemia, n = 187), Ab (localized ischemia with branch malperfusion, n = 67), Ac (generalized ischemia with circulatory collapse, n = 46), and Abc (localized and generalized ischemia, n = 51). Early and late outcomes were compared between groups. In-hospital mortality was 3% (6 of 187) for Penn Aa, 6% (4 of 67) for Penn Ab, 17% (8 of 46) for Penn Ac, and 22% (11 of 51) for Penn Abc. Multivariate logistic regression analysis showed Penn classes Ac and Abc, operation time >6 hours, and entry in the descending thoracic aorta to be risk factors for in-hospital mortality. Incidences of neurologic, respiratory, and hepatic complications differed between groups. Five-year cumulative survival was 85% in the Penn Aa group, 74% in the Penn Ab group (p = 0.027 vs Penn Aa), 78% in the Penn Ac group, and 67% in the Penn Abc group (p