Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection
Risk factors for spinal cord injury in patients undergoing frozen elephant trunk technique for acute aortic dissection
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DOI：
10.1007/s11748-019-01196-2
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发表时间：
2020-04-01
影响因子：
1.2
通讯作者：
Yamaguchi, Atsushi
中科院分区：
文献类型：
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作者：
Hori, Daijiro;Kusadokoro, Sho;Yamaguchi, Atsushi
本研究的目的是评估急性主动脉夹层患者接受冷冻象鼻技术（FET）手术后脊髓损伤（SCI）的危险因素。方法2014年12月至2018年2月，17例急性主动脉夹层患者接受了FET主动脉弓手术治疗。3例发生脊髓损伤。评估SCI的危险因素。结果患者平均年龄56岁，男性占88.2%。隆突、主动脉瓣和腹腔动脉水平的真腔与主动脉总直径的比值术前为0.48，术后为0.75，P < 0.001;主动脉瓣水平的真腔与主动脉总直径的比值术前为0.47，术后为0.67，P = 0.001;腹腔动脉水平的真腔与主动脉总直径的比值术前为0.48，术后为0.68，P = 0.003。有和没有SCI的患者之间的围手术期最低血红蛋白水平和术后平均动脉压没有显着差异。然而，SCI患者术前肌酐水平较高（SCI：1.32 mg/dL vs.无SCI：0.81 mg/dL，P = 0.023）。尽管术前开放的肋间动脉数量没有差异，但SCI患者中起源于真腔的肋间动脉数量较少（SCI：2.7 vs.无SCI：8.6，P = 0.021）。此外，在入口闭合后，观察到源自假腔的肋间动脉的通畅性显著降低（术前：3.1 vs.术后：1.0，P < 0.001）。结论FET可有效地封堵肺门。然而，在肌酐水平较高的患者中，FET可能是术后SCI的危险因素。
Background The purpose of this study was to evaluate the risk factors for spinal cord injury (SCI) in patients with acute aortic dissection undergoing surgery with frozen elephant trunk technique (FET). Methods From December 2014 to February 2018, 17 patients with acute aortic dissection underwent surgical treatment of the aortic arch with FET. SCI occurred in 3 patients. Risk factors for SCI were evaluated. Results Mean age of the patients was 56 years and 88.2% were male. The ratio of true lumen to total aortic diameter at the level of carina (before: 0.48 vs. after: 0.75, P < 0.001), aortic valve (before: 0.47 vs. after: 0.67, P = 0.001), and celiac artery (before: 0.48 vs. after: 0.68, P = 0.003) increased after surgery. There were no significant differences in perioperative minimum hemoglobin level and postoperative mean arterial pressure between patients with and without SCI. However, patients with SCI had higher creatinine level before surgery (SCI: 1.32 mg/dL vs. no SCI: 0.81 mg/dL, P = 0.023). Although there was no difference in number of patent intercostal arteries before surgery, those originating from the true lumen were fewer in patients with SCI (SCI: 2.7 vs. no SCI: 8.6, P = 0.021). Furthermore, with entry closure, significant decrease in patency was observed in intercostal arteries originating from the false lumen (before: 3.1 vs. after: 1.0, P < 0.001). Conclusion FET was useful in entry closure. However, FET in patients with higher creatinine level and those who may have significant spinal cord perfusion from the false lumen could be a risk factor for postoperative SCI.