Analysis of perioperative risk factors in mortality and morbidity after modified Bentall operation
Analysis of perioperative risk factors in mortality and morbidity after modified Bentall operation
复制标题
DOI：
10.1536/jhj.43.151
复制
发表时间：
2002-03-01
期刊：
影响因子：
--
通讯作者：
Durmaz, I
中科院分区：
文献类型：
--
作者：
Apaydin, AZ;Posacioglu, H;Durmaz, I
在1994年7月至2001年2月期间，86例患者（70例男性）在我院接受了改良的本特尔手术，目的是确定本特尔手术后短期死亡率和发病率的危险因素。主动脉病理为急性主动脉夹层12例（14%），慢性夹层9例（10.5%），退行性动脉瘤65例（75.6%）。平均年龄48±15岁。采用单因素和多因素logistic回归分析，对患者术前11个、术中8个、术后6个变量进行回顾性分析。6例患者在院内死亡（6.9%），2例患者在出院后4个月内死亡。平均随访时间33 23个月（2个月~ 8年）。住院幸存者3年生存率为88%，6年生存率为77%。术后出现主动脉瓣钙化、主动脉瓣狭窄、肾功能衰竭和心力衰竭是住院和短期死亡率的单因素预测因素。多因素分析未发现独立危险因素。发病的危险因素是急性夹层的病因、使用静息循环、输血和新鲜冷冻血浆各超过2单位、交叉钳夹和体外循环次数（分别超过90分钟和140分钟）以及执行伴随手术。改良的本特尔手术一般来说是安全的。细致的解剖、小心的操作和冠状动脉按钮的定位对主动脉根部僵硬的患者至关重要，因为技术错误更容易发生。
The objective of the present study was to determine the risk factors for operative and short-term mortality, and morbidity after a Bentall operation, Between July 1994 and February 2001, 86 consecutive patients (70 males) Underwent a modified Bentall operation at our hospital. The aortic pathology was acute aortic dissection in 12 (14%), chronic dissection in 9 (10.5%) and degenerative aneurysm in 65 (75.6%). Mean age was 48 +/- 15 years. Eleven preoperative, 8 intraoperative and 6 postoperative variables of these patients were retrospectively analyzed using univariate and multivariate logistic regression analysis. Six patients died in the hospital (6.9%) and 2 died within four months after being discharged from the hospital. Mean follow-up time was 33 23 months (2 months to 8 years). The survival rate among hospital survivors was 88% at 3 years and 77% at 6 years. Univariate predictors of in-hospital and short-term mortality were the presence of aortic valve calcification, stenotic aortic valves, renal failure, and cardiac failure after the operation. Multivariate analysis revealed no independent risk factors. Risk factors for morbidity were etiology of acute dissection, use of circulatory at-rest, transfusion of blood and fresh frozen plasma more than 2 units each, cross clamp and cardiopulmonary bypass times (exceeding 90 and 140 minutes, respectively), and performing concomitant procedures.Modified Bentall procedures are safe in general. Meticulous dissection, careful handling and positioning of the coronary buttons are of paramount importance in patients with stiff aortic root since technical errors are more likely to occur.