Risk factors for cerebral complications after type A aortic dissection surgery: single center's experience
Risk factors for cerebral complications after type A aortic dissection surgery: single center's experience
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DOI：
10.21037/apm-20-2365
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发表时间：
2021-07-01
影响因子：
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通讯作者：
Wang, Dongjin
中科院分区：
文献类型：
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作者：
Xue, Yunxing;Liu, Chang;Wang, Dongjin
背景：本研究的目的是回顾性回顾A型主动脉夹层（TAAD）手术后脑并发症（CC）的发生率和危险因素。方法：共纳入746例接受低温循环停止（HCA）手术的TAAD患者。术后CC定义为颅内出血或缺血性脑梗死，经颅脑CT扫描证实。采用多变量logistic回归分析探讨CC和死亡率的危险因素。为了确定弓修复方法和血流率在顺行脑灌注（ACP）中的风险作用，进行了倾向评分匹配研究（保守与全弓置换，n=135；低与正常血流率，n=148）。结果：35例患者发生CC（颅内出血6例，缺血性脑卒中29例）。CC患者的30天死亡率（34.3%）显著高于非CC患者（12.2%）。多变量logistic回归分析发现术前脑缺血、肢体缺血、终末期肾脏疾病和抢救手术是术后CC的危险因素，CAR （P=0.044；优势比4.587;95% CI: 1.045-20.130）和低流量ACP （P=0.046；优势比2.139;95% CI: 1.014-4.515）具有保护作用。在倾向评分匹配研究中，CAR组（分别为0.7%和9.6%，P=0.005和0.175）和低流量ACP组的死亡率（分别为8.8%和5.4%，P=0.067和0.012）和CC的发生率较低。结论：TAAD术后CC是常见且致死性的。低流量ACP是一种较为安全、合适的顺行灌注脑保护方法。
Background: The objective of this study was to retrospectively review the rate and risk factors of cerebral complications (CC) after type A aortic dissection (TAAD) surgery.Methods: A total of 746 TAAD patients who underwent hypothermic circulatory arrest (HCA) surgery were enrolled. Postoperative CC were defined as intracranial hemorrhage or ischemic infarct stroke as confirmed by cranial CT scan. Multivariable logistic regression analysis was used to investigate the risk factors for CC and mortality. To identify the risk role of arch repair methods and flow rate in antegrade cerebral perfusion (ACP), propensity-score matching studies were performed (conservative vs. total arch replacement, n=135; low vs. normal flow rate, n=148).Results: Thirty-five patients developed CC (6 with intracranial hemorrhage and 29 with ischemic stroke). Thirty-day mortality (34.3%) among patients with CC was significantly higher than that among patients without CC (12.2%). Multivariable logistic regression analysis identified preoperative cerebral ischemia, limb ischemia, end-stage renal disease, and salvage surgery as risk factors for postoperative CC. CAR (P=0.044; odds ratio, 4.587; 95% CI: 1.045-20.130) and low flow rate ACP (P=0.046; odds ratio, 2.139; 95% CI: 1.014-4.515) had protective roles. In the propensity-score matching studies, the CAR group (0.7% and 9.6%, P=0.005 and 0.175, respectively) and the low flow rate ACP group had lower rates of mortality (8.8% and 5.4%, P=0.067 and 0.012, respectively) and CC.Conclusions: CC are common and lethal after TAAD surgery. Low-flow ACP could be a safer and suitable antegrade perfusion method for cerebral protection.