Aortic Dissection as a Complication of Cardiac Surgery: Report From The Society of Thoracic Surgeons Database
Aortic Dissection as a Complication of Cardiac Surgery: Report From The Society of Thoracic Surgeons Database
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DOI：
10.1016/j.athoracsur.2010.05.023
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发表时间：
2010-11-01
影响因子：
4.6
通讯作者：
Hughes, G. Chad
中科院分区：
文献类型：
--
作者：
Williams, Matthew L.;Sheng, Shubin;Hughes, G. Chad
背景主动脉夹层作为心脏手术的并发症是一种罕见的，但往往是致命的事件。我们试图在STS（胸外科医师协会）数据库中确定这种并发症的频率以及术中主动脉夹层患者的结局。然后，我们开发了一个模型，以确定术前特征和术中因素与并发症。STS数据库中接受冠状动脉旁路移植术、主动脉瓣手术或二尖瓣手术的所有患者均纳入研究。排除标准包括任何因主动脉夹层而需要紧急手术的患者。然后分析收集的数据，以描述主动脉夹层作为并发症的频率及其后果。然后，我们分析了一个更近的时代，包括信息的动脉插管部位（股动脉-其他与主动脉），以确定主动脉夹层的危险因素。在分析的2，219，991例患者中，1，294例患者发生了主动脉夹层作为手术并发症，发生率为0.06%。这种并发症经常导致灾难性的结果，1，294例手术中有615例（48%）死亡。根据2004年至2007年STS数据建立了逻辑回归模型。在分析的680，025例患者中，436例患者患有主动脉夹层。分析得出9个显著的危险因素，包括股动脉插管、术前类固醇和亚洲人种;糖尿病的存在似乎具有保护作用。主动脉夹层是心脏手术的一种罕见但灾难性的并发症。股动脉插管与该并发症的发生率增加相关。
Background. Aortic dissection as a complication of cardiac surgery is a rare but often lethal event. We sought to determine the frequency of this complication in the STS (Society of Thoracic Surgeons) database as well as the outcomes of patients who suffer intraoperative aortic dissection. We then developed a model to identify preoperative characteristics and intraoperative factors associated with the complication.Methods. All patients from the STS database who underwent coronary artery bypass grafting, aortic valve surgery, or mitral valve surgery were included. Exclusion criteria included any patient who had aortic dissection listed as a reason for urgent or emergent operation. Data collected were then analyzed to describe the frequency of aortic dissection as a complication as well as its consequences. We then analyzed a more recent era that included information on arterial cannulation site (femoral-other versus aortic) to identify risk factors for aortic dissection.Results. Of 2,219,991 patients analyzed, 1,294 suffered aortic dissection as a complication of their surgery, for an incidence of 0.06%. This complication frequently led to catastrophic results, with 615 of 1,294 (48%) operative mortality. A logistic regression model was created based on 2004 to 2007 STS data. Of 680,025 patients analyzed, 436 patients suffered an aortic dissection. The analysis yielded nine significant risk factors including femoral arterial cannulation, preoperative steroids, and Asian race; the presence of diabetes appeared to be protective.Conclusions. Aortic dissection is a rare but catastrophic complication of cardiac surgery. Femoral cannulation is associated with an increased frequency of this complication.