Current status of open surgery for acute type A aortic dissection in Japan
Current status of open surgery for acute type A aortic dissection in Japan
复制标题
DOI：
10.1016/j.jtcvs.2020.09.147
复制
发表时间：
2022-08-10
影响因子：
6
通讯作者：
Takamoto, Shinichi
中科院分区：
文献类型：
--
作者：
Okita, Yutaka;Kumamaru, Hiraku;Takamoto, Shinichi
目的：利用日本心血管数据库报道急性主动脉夹层开腹手术的临床结果。方法：在2013年至2018年期间，共有29,486例接受开放手术的急性主动脉夹层患者在日本心血管数据库中登记。约50%的患者为男性。手术年龄59.8±14.2岁；61%的患者年龄小于65岁，21%的患者年龄大于75岁。结缔组织病见于1.2%的患者。约13%的患者意识障碍，12%的患者心源性休克。约11%的患者有中度或重度主动脉瓣反流，2.3%的患者有急性心肌梗死。约94%的患者在确诊后24小时内接受了手术。74%的患者行顺行脑灌注，17.1%的患者行逆行脑灌注的低温循环骤停，9.4%的患者行深度低温循环骤停。体外循环时间216 +/- 90分钟，心脏缺血时间132 +/- 60分钟。最低体温为24.6℃+/- 3.2℃，69%的患者行升主动脉（I区）置换术，29%的患者行全弓置换术（o区至II区，III-）。7.9%的患者更换了主动脉瓣，4.4%的患者修复了主动脉瓣。结果：30天死亡率为9.2%，住院死亡率为11%。在研究期间，手术的数量有所增加。住院死亡率稳定或呈下降趋势。主要并发症包括12%的患者中风，7.3%的患者进行新的血液透析，3.9%的患者脊髓缺血，15%的患者延长通气时间。结论：根据日本全国数据库，近6年（2013 - 2018年）约有30,000名急性主动脉夹层患者接受了开放手术。手术次数增加，住院死亡率稳定或呈下降趋势。虽然早期结果是可以接受的，但术前合并症患者仍有改善的余地。
Objective: The study objective was to report the clinical outcomes of open surgery for acute aortic dissection by using the Japan Cardiovascular Database.Methods: Between 2013 and 2018, a total of 29,486 patients with acute aortic dissection who underwent open surgery were registered in the Japan Cardiovascular Database. Some 50% of patients were male. Age of patients at surgery was 59.8 +/- 14.2 years; 61% of patients were aged less than 65 years, and 21 % of patients were aged more than 75 years. Connective tissue disease was found in 1.2% of patients. Some 13% of patients had disturbed consciousness, and 12% of patients had cardiogenic shock. Some 11% of patients had moderate or severe aortic valve regurgitation, and 2.3% of patients had acute myocardial infarction. Some 94% of patients underwent surgery within 24 hours after diagnosis. Antegrade cerebral perfusion was used in 74% of patients, hypothermic circulatory arrest with retrograde cerebral perfusion was used in 17.1% of patients, and deep hypothermic circulatory arrest was used in 9.4% of patients. Cardiopulmonary bypass time was 216 +/- 90 minutes, and cardiac ischemic time was 132 +/- 6o minutes. Lowest body temperature was 24.6 degrees C +/- 3.2 degrees C. Replacement of the ascending aorta (zone I) was performed in 69% of patients, and total arch replacement (zone o to zone II, III-) was performed in 29% of patients. The aortic valve was replaced in 7.9% of patients and repaired in 4.4% of patients.Results: The 30-day mortality was 9.2%, and in-hospital mortality was 11%. The number of operations has increased through the study periods. The in-hospital mortality has been stable or in a decreasing trend. Major complications consisted of stroke in 12% of patients, new hemodialysis in 7.3% of patients, spinal cord ischemia in 3.9% of patients, and prolonged ventilation in 15% of patients.Conclusions: Approximately 30,000 patients with acute aortic dissection in the recent 6 years (2013 - 2018) underwent open surgery according to the nationwide Japanese database. The number of operations has increased, and in-hospital mortality has been stable or in a decreasing trend. Although the early outcomes are acceptable, there is still room for improvement in patients with preoperative comorbidities.