Deep hypothermic circulatory arrest versus non-deep hypothermic beating heart strategy in descending thoracic or thoracoabdominal aortic surgery
Deep hypothermic circulatory arrest versus non-deep hypothermic beating heart strategy in descending thoracic or thoracoabdominal aortic surgery
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DOI：
10.1093/ejcts/ezu053
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发表时间：
2014-10-01
影响因子：
3.4
通讯作者：
Lee, Jae Won
中科院分区：
文献类型：
--
作者：
Yoo, Jae Suk;Kim, Joon Bum;Lee, Jae Won
目的：在胸降主动脉(DTA)或胸腹主动脉(TAA)的开放手术修复中，理想的体外循环(CPB)策略是有争议的。方法：1994年1月至2011年8月，259例心脏直视手术患者接受深低温停循环和非深低温心脏不停跳心内直视手术。对212例同时适用于深低温心动图(n=79)和非深低温心动图(n=109)的患者进行了分析。使用倾向性评分和基于20个术前变量的逆概率加权调整来比较住院结果，以减少治疗选择偏差。结果：早期死亡率：深低温腹腔镜组为12.7%，非深低温腹腔镜组为7.5%(P=0.23)。主要不良反应包括卒中13例(6.1%)，截瘫10例(4.7%)，低心排综合征17例(8.0%)，多器官功能衰竭12例(5.7%)。调整后，接受深低温体外循环的患者的死亡风险(OR值为1.86；P=0.18)和永久性神经损伤的风险(OR值为1.06；P=0.9)与未接受深低温体外循环的患者相似，但发生LCOS的风险更高(OR为3.85；P=0.012)。与非深低温体外循环组相比，深低温体外循环组呼吸机支持时间延长(>；24 h)的发生率更高(OR，2.33；P=0.004)。结论：与非深低温体外循环组相比，深低温体外循环组术后LCOS风险增加，呼吸机支持时间延长。因此，对于开放的DTA/TAA修补术，只要符合主动脉解剖结构，非深低温心脏停搏似乎是比深低温停搏更合适的选择。
OBJECTIVES: The ideal cardiopulmonary bypass (CPB) strategy during open surgical repair of the descending thoracic aorta (DTA) or thoracoabdominal aorta (TAA) is controversial. This study aimed to compare the clinical outcomes between deep hypothermic circulatory arrest (DHCA) and non-deep hypothermic beating heart CPB (non-DHCA) for DTA or TAA replacement.METHODS: From January 1994 to August 2011, 259 patients underwent DTA or TAA replacement. Of these, 212, who were judged to be suitable for both DHCA (n = 79) and non-DHCA (n = 109), were analysed. In-hospital outcomes were compared using propensity scores and inverse-probability-weighting adjustment based on 20 preoperative variables to reduce treatment selection bias.RESULTS: Early mortality was 12.7% in the DHCA group and 7.5% in the non-DHCA group (P = 0.23). Major adverse outcomes included stroke in 13 patients (6.1%), paraplegia in 10 (4.7%), low cardiac output syndrome (LCOS) in 17 (8.0%) and multiorgan failure in 12 (5.7%). After adjustment, patients who underwent DHCA were at a risk of death (odds ratio (OR), 1.86; P = 0.18) and permanent neurological injury (OR, 1.06; P = 0.90) similar to that of those who underwent non-DHCA, but at greater risk of LCOS (OR, 3.85; P = 0.012). Furthermore, prolonged ventilator support (>24 h) was more frequent with DHCA than with non-DHCA (OR, 2.33; P = 0.004).CONCLUSIONS: Compared with non-DHCA, DHCA was associated with greater risk of postoperative LCOS and prolonged ventilator support. Therefore, non-DHCA seems to be a more appropriate option than DHCA for open DTA/TAA repair whenever the aortic anatomy lends itself to this approach.