Strategies to improve outcomes for acute type A aortic dissection with cerebral malperfusion
Strategies to improve outcomes for acute type A aortic dissection with cerebral malperfusion
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DOI：
10.1093/ejcts/ezaa376
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发表时间：
2021-03-01
影响因子：
3.4
通讯作者：
Okada, Kenji
中科院分区：
文献类型：
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作者：
Gomibuchi, Toshihito;Seto, Tatsuichiro;Okada, Kenji
目的：我们的目的是确定术后永久性神经功能缺损（PND）的预测因素，并评估脑灌注不良的急性A型主动脉夹层手术修复患者的早期脑灌注管理方法：2009年10月至2018年9月，共有197例急性A型主动脉夹层患者接受主动脉置换术。其中，42例（21.3%）患者有影像学脑灌注不良（ICM）。术前评估ICM，这也显示夹层主动脉上分支血管是否被血栓形成的假腔闭塞或狭窄。2017年9月后，对ICM患者进行了早期再灌注和解剖外血运重建。结果：ICM患者的住院死亡率为4.8%（2/42）。2017年9月前，PND：ICM患者中有6例（54.5%）术前有神经系统症状（n=11），7例（33.3%）无神经系统症状（n=21）。主动脉上分支血管闭塞或严重狭窄（优势比，7.66; P
OBJECTIVES: We aimed to identify predictors of postoperative permanent neurological deficits (PNDs) and evaluate the early management of cerebral perfusion in patients undergoing surgical repair of acute type A aortic dissection with cerebral malperfusion.METHODS: Between October 2009 and September 2018, a total of 197 patients with acute type A aortic dissection underwent aortic replacement. Of these, 42 (21.3%) patients had an imaging cerebral malperfusion (ICM). ICM was assessed preoperatively, which also revealed whether dissected supra-aortic branch vessels were occluded or narrowed by a thrombosed false lumen. After September 2017, early reperfusion and extra-anatomic revascularization were performed in cases with ICM.RESULTS: Hospital mortality rates for cases with ICM were 4.8% (2/42). Before September 2017, PND were : observed in 6 patients (54.5%) with preoperative neurological symptoms (n=11), and 7 patients (33.3%) without neurological symptoms (n=21) in patients with ICM. Occlusion or severe stenosis of supra-aortic branch vessels (odds ratio, 7.66; P