Immediate operation for acute type A aortic dissection complicated by visceral or peripheral malperfusion
Immediate operation for acute type A aortic dissection complicated by visceral or peripheral malperfusion
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DOI：
10.1016/j.jtcvs.2018.01.096
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发表时间：
2018-07-01
影响因子：
6
通讯作者：
Fischbein, Michael P.
中科院分区：
文献类型：
--
作者：
Chiu, Peter;Tsou, Sarah;Fischbein, Michael P.
目的：评估内脏、肾脏或外周灌注不良对急性 A 型主动脉夹层结局的影响。方法：我们对 2005 年 1 月至 2015 年 12 月期间在斯坦福医院的急性 A 型主动脉夹层经验进行回顾性分析。采用逆概率加权来解释经历过灌注不良综合征的患者与未经历过灌注不良综合征的患者之间的差异。使用加权logistic回归评估院内死亡率，并使用限制平均生存时间和加权Cox回归评估中期生存。以死亡作为竞争风险来评估再干预。结果：有 305 名 A 型夹层患者超出升主动脉，其中 82 名 (26.9%) 出现灌注不良综合征。加权逻辑回归显示，灌注不良亚组的院内死亡率与无灌注不良的患者没有差异，比值比为 1.50（95% 置信区间，0.65-3.47；P = .3）。使用限制平均生存时间，8 年时灌注不良患者与无灌注不良患者的中期生存率没有差异，为 -50.2 天（95% CI，-366.8 至 266.4；P = .8）。在 10 年加权分析中，与没有灌注不良的患者 (5.7%) 相比，灌注不良的患者接受主动脉分支干预的风险增加 (12.5%)，风险比为 3.06 (95% CI，1.24-7.56；P = .02)。灌注不良患者主动脉分支再干预的中位时间为 2 天，而无灌注不良患者则为 230 天，P = .01。结论：急性 A 型主动脉夹层并发灌注不良立即手术可获得良好结果。
Objective: To evaluate the effect of visceral, renal, or peripheral malperfusion on the outcome of acute type A aortic dissection.Methods: We performed a retrospective review of the acute type A aortic dissection experience at Stanford Hospital between January 2005 and December 2015. Inverse probability weighting was used to account for differences between patients who experienced malperfusion syndromes and those who did not. Weighted logistic regression was used to evaluate in-hospital mortality, and midterm survival was assessed with the restricted mean survival time and weighted Cox regression. Reintervention was assessed with death as a competing risk.Results: There were 305 patients with type A dissection extending beyond the ascending aorta, and 82 (26.9%) presented with a malperfusion syndrome. In-hospital mortality in the malperfusion subgroup was no different compared with patients without malperfusion in weighted logistic regression, odds ratio, 1.50 (95% confidence interval, 0.65-3.47; P = .3). There was no difference in midterm survival using restricted mean survival time, -50.2 days (95% CI, -366.8 to 266.4; P = .8) in patients with malperfusion compared with patients without malperfusion at 8 years. Patients with malperfusion had an increased risk of interventions (12.5%) on aortic branches compared with patients without (5.7%) in weighted analysis at 10-years, hazard ratio, 3.06 (95% CI, 1.24-7.56; P = .02). The median time to reintervention on aortic branches was 2 days for patients with malperfusion compared with 230 days without malperfusion, P = .01.Conclusions: Immediate operation for acute type A aortic dissection complicated by malperfusion is associated with good results.