Surgical results of acute aortic dissection complicated with cerebral malperfusion
Surgical results of acute aortic dissection complicated with cerebral malperfusion
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DOI：
10.1016/j.athoracsur.2004.12.049
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发表时间：
2005-07-01
影响因子：
4.6
通讯作者：
Okita, Y
中科院分区：
文献类型：
--
作者：
Tanaka, H;Okada, K;Okita, Y
背景。在急性A型主动脉夹层诊断患者中，由于脑疏松率复杂，手术治疗仍然具有挑战性。这项回顾性研究报告了这些患者的手术干预措施和临床特征的结果。从1999年到2004年，有63例患者接受了急性A型主动脉夹层的手术治疗。 16例患者（25.3％）出现术前新发育的神经系统缺陷（脑疏松率）。在患有脑疏松注理的患者中，审查了特征，神经系统症状，计算机断层扫描结果，从发作到手术的间隔以及手术细节（程序，动脉插管部位，脑部保护方法）。医院的死亡率为脑疏松组的43.7％（16例患者中的7例），非脑疏松率组为17.0％（47例患者中的8例）（所有患者，23.8％）。多变量分析表明术前脑疏松症是医院死亡率的唯一风险因素。六名患者，包括术前昏迷的所有患者，在手术后1个月内死于严重的脑部损伤。大多数患者被术后脑计算机断层扫描被诊断出患有右半球脑梗塞。从发作到手术的手术细节和时间间隔不是死亡的重要预测指标。没有脑疏松的患者为4年的累积存活率为75.5％，脑疏松率为50.1％（p = 0.091）。结论。急性A型急性A型外科治疗与脑疏松率复杂的急性A型解剖学表现出高医院的死亡率，但长期生存率与没有脑疏松注musion的患者相似，具有可接受的神经系统效果，不包括术前昏迷患者。应对缺血性脑组织进行适当的保护，以改善这些患者的手术结果。 （c）2005年由胸外科医师协会。
Background. In patients with acute type A aortic dissection complicated by cerebral malperfusion, the surgical treatment remains challenging. This retrospective study reports the results of surgical interventions and the clinical features of these patients.Methods. From 1999 to 2004, 63 patients underwent surgical treatment for acute type A aortic dissection. Sixteen patients (25.3%) showed preoperative newly developed neurologic deficits (cerebral malperfusion). In patients with cerebral malperfusion, the characteristics, neurologic symptoms, computed tomography findings, interval from onset to operation, and operative details (procedure, arterial cannulation site, method of brain protection) were reviewed.Results. The hospital mortality rate was 43.7% (7 of 16 patients) for the cerebral malperfusion group and 17.0% (8 of 47 patients) for the noncerebral malperfusion group (all patients, 23.8%). Multivariate analysis showed preoperative cerebral malperfusion as the sole risk factor for hospital mortality. Six patients, including all patients in a preoperative coma, died of severe brain damage within 1 month after surgery. Most patients were diagnosed with right hemispheric cerebral infarction by postoperative brain computed tomography. The operative details and the time interval from onset to operation were not significant predictors of death. The cumulative survival rate at 4 years was 75.5% in patients without cerebral malperfusion and 50.1% with cerebral malperfusion (p = 0.091).Conclusions. The results of surgical treatment for acute type A dissection complicated with cerebral malperfusion demonstrated high hospital mortality, but the long-term survival was similar to patients without cerebral malperfusion, with an acceptable neurologic outcome, excluding preoperative coma patients. Appropriate protection of ischemic brain tissue should be implemented to improve the surgical results in these patients. (c) 2005 by The Society of Thoracic Surgeons.