Early and late risk factors in surgical treatment of acute type A aortic dissection
Early and late risk factors in surgical treatment of acute type A aortic dissection
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DOI：
10.1016/s0003-4975(98)00555-4
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发表时间：
1998-09-01
影响因子：
4.6
通讯作者：
di Summa, M
中科院分区：
文献类型：
--
作者：
Pansini, S;Gagliardotto, PV;di Summa, M
背景A型主动脉夹层动脉瘤急诊修复的发病率和死亡率很高。这是一个试图调查的风险决定因素的早期和晚期的结果。从1979年1月1日至1995年12月31日手术的291例患者的临床记录中回顾性收集了一系列术前和手术变量。采用单因素分析和逐步Logistic回归分析手术死亡的危险因素。1995年12月至1996年2月进行了随访。采用精算生存曲线（寿命法）对晚期结果进行分析。剔除手术死亡后，采用考克斯模型分析晚期死亡的危险因素。住院死亡率为36.1%。手术或早期死亡的重要独立决定因素是术前休克、术前神经功能缺损、1986年以前手术、围手术期出血和钳夹时间延长。10年生存率为36.9% ± 4.4%。26例患者需要再次手术。需要再次手术的患者的长期预后明显较差。结论。随着对这种疾病认识的提高和诊断的迅速进行，急性升主动脉夹层患者的早期手术数量也在增加。这一新的挑战必须通过更好的术前支持和术中监测以及专注于降低晚期并发症发生率的手术技术来应对，必须提供终身随访。(Ann Thorac Surg 1998;66：779-84）（C）1998年，胸外科医师协会。
Background. Morbidity and mortality of emergency repair of type A dissecting aneurysms of the aorta are high. This is an attempt to investigate the risk determinants of early and late results.Methods. A series of preoperative and operative variables were retrospectively collected from the clinical records of 291 patients operated on between January 1, 1979, and December 31, 1995. Risk factors for surgical death were investigated with univariate analysis and stepwise logistic regression. Follow-up was conducted between December 1995 and February 1996. Analysis of late results was conducted by means of actuarial survival curves (life method). After removing the surgical deaths, risk factors for late deaths were analyzed by a Cox model.Results. The in-hospital mortality rate was 36.1%. Significant independent determinants of operative or early death were preoperative shock, preoperative neurologic impairment, operation before 1986, perioperative bleeding, and prolonged clamping time. The 10-year survival rate was 36.9% +/- 4.4%. Twenty-six patients required repeat operation. The long-term prognosis was significantly worse in patients who needed reoperation.Conclusions. Growing awareness of this disease and quicker diagnosis have increased the number of patients with acute dissection of the ascending aorta who are taken early to operation. This new challenge must be met by better preoperative support and intraoperative monitoring, and by surgical techniques that focus on lowering the rate of late complications, for which lifelong follow-up must be provided. (Ann Thorac Surg 1998;66:779-84) (C) 1998 by The Society of Thoracic Surgeons.