Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair
Unilateral is comparable to bilateral antegrade cerebral perfusion in acute type A aortic dissection repair
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DOI：
10.1016/j.jtcvs.2019.07.108
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发表时间：
2020-09-01
影响因子：
6
通讯作者：
Yang, Bo
中科院分区：
文献类型：
--
作者：
Norton, Elizabeth L.;Wu, Xiaoting;Yang, Bo
目的：比较单侧和双侧顺行脑灌注(uni-ACP和bi-ACP)在急性A型主动脉夹层(ATAAD)修补术中的近期和远期疗效。方法：2001-2017年间，307例ATAAD患者分别采用uni-ACP和bi-ACP进行手术治疗。通过心脏外科数据仓库、病历回顾和国家死亡指数数据库收集数据。结果：单一ACP组和双ACP组的人口学特征和术前合并症相似。两组在主动脉瓣/根部、升主动脉、冷冻象鼻和其他伴随手术中的手术率相似。两组围手术期结局无显著差异(30天死亡率：Uni-ACP 3.4%vs bi-ACP 7.8%，P=.12)，但再次手术出血在Uni-ACP组显著低于Uni-ACP组(5%vs 12%，P=.03)。在uni-ACP组和bi-ACP组之间，总的术后卒中发生率(6%比9%，P=0.4)和左脑卒中发生率(0.7%比3.0%，P=0.23)没有显著差异。单ACP与双ACP对术后卒中的优势比为0.87(P=.80)，对手术死亡率的优势比为0.86(P=.81)。单一ACP组的中期生存率较好，P=0.027(5年：84%对76%)。单ACP组与双ACP组的总死亡率风险比为0.74(95可信区间为0.33~1.65)，P=0.46。结论：在ATAAD中，单ACP组和双ACP组均能有效地保护大脑，且术后卒中发生率和半弓至三区弓置换的死亡率均较低。UNI-ACP操作简单，对弓支血管操作较少，值得推荐。
Objective: To compare the short- and long-term outcomes of unilateral and bilateral antegrade cerebral perfusion (uni-ACP and bi-ACP) in acute type A aortic dissection (ATAAD) repair.Methods: From 2001 to 2017, 307 patients underwent surgical repair of an ATAAD using uni-ACP (n = 140) and bi-ACP (n = 167). Data were collected through the Department of Cardiac Surgery Data Warehouse, medical record review, and the National Death Index database.Results: The demographics and preoperative comorbidities were similar between the uni-ACP and bi-ACP groups. Both groups had similar rates of procedures for aortic valve/root, ascending aorta, frozen elephant trunk, and other concomitant procedures. Perioperative outcomes were not significantly different between the 2 groups (30 -day mortality: uni-ACP 3.4% vs bi-ACP 7.8%, P = .12) except re operation for bleeding was significantly lower in uni-ACP (5% vs 12%, P = .03). Between the uni-ACP and bi-ACP groups, overall postoperative stroke rate (6% vs 9%, P = .4) and left brain stroke rate (0.7% vs 3.0%, P = .23) were not significantly different. The odds ratio of uni-ACP versus bi-ACP was 0.87 (P = .80) for postoperative stroke and 0.86 (P = .81) for operative mortality. The mid-term survival was better in the uni-ACP group, P = .027 (5-year: 84% vs 76%). The hazard ratio of all-time mortality for uni-ACP versus bi-ACP was 0.74 (95 confidence interval, 0.33-1.65), P = .46.Conclusions: In ATAAD, both uni-ACP and bi-ACP are equally effective to protect the brain with low postoperative stroke rates and mortality in hemiarch to zone 3 arch replacement. Uni-ACP is recommended for its simplicity and less manipulation of arch branch vessels.