Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair
Morbidity and mortality after extent II thoracoabdominal aortic aneurysm repair
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DOI：
10.1016/s0003-4975(02)03370-2
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发表时间：
2002-04-01
影响因子：
4.6
通讯作者：
Schmittling, ZC
中科院分区：
文献类型：
--
作者：
Coselli, JS;LeMaire, SA;Schmittling, ZC
背景资料。克劳福德二期胸腹主动脉瘤(TAAA)的外科修复具有很大的发病率和死亡率风险。本研究的目的是分析一系列连续的大范围二尖瓣修复的结果，并找出影响发病率和存活率的因素。在13年期间连续接受TaA手术的1,415名患者中，442名(31.2%)接受了II度修复。对来自前瞻性维护的数据库的数据进行分析，以确定哪些因素与死亡和主要并发症有关。手术死亡率为10.0%(44例)。术后并发症包括截瘫/截瘫33例(7.5%)，肺部并发症158例(35.7%)，肾功能衰竭69例(15.9%)。多因素分析显示，肾功能不全(增加比[OR]2.6)、年龄增加(OR 1.1/年)和红细胞输注需求增加(OR 1.1/U)是死亡的预测因素；肾功能不全(OR 2.8)和消化性溃疡疾病(OR 9.3)是肾功能衰竭的预测因素；破裂(OR 6.3)是截瘫的预测因素。左心转流是预防截瘫的独立保护因素(OR0.4)。这一当代经验表明，在这一高危人群中，发病率和死亡率水平可以接受。左心搭桥术被发现对这些患者的截瘫有保护作用。(C)2002年，由胸外科医生学会提供。
Background. Surgical repair of Crawford extent II thoracoabdominal aortic aneurysms (TAAAs) carries substantial risk for morbidity and mortality. The purpose of this study was to analyze the results of a large consecutive series of extent II TAAA repairs and identify factors that influence morbidity and survival.Methods. Of 1,415 consecutive patients who underwent TAAA operations over a 13-year period, 442 (31.2%) had extent II repairs. Data from a prospectively maintained database were analyzed to determine which factors were associated with death and major complications.Results. The operative mortality was 10.0% (44 patients). Postoperative complications included paraplegia/paraparesis in 33 patients (7.5%), pulmonary complications in 158 (35.7%), and renal failure in 69 (15.9%). Multivariable analysis revealed that renal insufficiency (adds ratio [OR] 2.6), increasing age (OR 1.1/year), and increasing red blood cell transfusion requirements (OR 1.1/U) were predictors for mortality; renal insufficiency (OR 2.8) and peptic ulcer disease (OR 9.3) were predictors of renal failure; and rupture (OR 6.3) was a predictor of paraplegia. Left heart bypass was an independent protective factor against paraplegia (OR 0.4).Conclusions. This contemporary experience demonstrates acceptable levels of morbidity and mortality in this high-risk group. Left heart bypass was found to provide protection against paraplegia in these patients. (C) 2002 by The Society of Thoracic Surgeons.