Mortality and Morbidity After Total Aortic Arch Replacement
Mortality and Morbidity After Total Aortic Arch Replacement
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DOI：
10.1016/j.athoracsur.2014.01.014
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发表时间：
2014-05-01
影响因子：
4.6
通讯作者：
Hamano, Kimikazu
中科院分区：
文献类型：
--
作者：
Tanaka, Yuya;Mikamo, Akihito;Hamano, Kimikazu
背景全主动脉弓置换术与相当大的死亡率和发病率相关。虽然手术死亡是最极端的不良临床终点，但术后发病率对生存者也是毁灭性的。我们研究了2003年9月至2011年9月期间146例接受全主动脉弓置换术的患者的短期和长期结局。总的住院死亡率为4.8%，29例患者（19.9%）在住院期间发生了严重的术后并发症。多变量分析表明，医院死亡的危险因素为左胸切开术（比值比[OR]，51.92; p = 0.01）、术前血清肌酐值高（OR，3.88; p = 0.02）和术中失血量（OR，1.01; p = 0.04）。主动脉破裂（OR，7.13; p = 0.02）和既往心肌梗死（OR，5.13; p = 0.04）被确定为主要术后并发症的独立风险因素。所有患者术后5年生存率为76.7% ± 5%。出院后，标准化死亡率显示，医院幸存者与日本可比人群之间无显著差异，无重大发病患者的标准化死亡率为1.09（p = 0.41），有重大发病患者的标准化死亡率为1.82（p = 0.12）。发生需要血液透析的肾功能衰竭会增加长期死亡的风险（风险比，5.59; p = 0.03），即使在住院存活者中也是如此。我们的全牙弓置换术的住院死亡率和发病率较低。住院存活者的长期结局稳定，特别是在术后不需要透析的情况下。(C)2014年由胸外科医师协会
Background. Total aortic arch replacement is associated with considerable mortality and morbidity. Although operative death is the most extreme adverse clinical end point, postoperative morbidity can also be devastating for survivors.Methods. We examined the short-term and long-term outcomes of 146 patients who underwent total aortic arch replacements between September 2003 and September 2011.Results. The overall in-hospital mortality was 4.8%, and major postoperative morbidity during hospitalization occurred in 29 patients (19.9%). Multivariate analyses demonstrated that risk factors for hospital death were left thoracotomy (odds ratio [OR], 51.92; p = 0.01), high pre-operative serum creatinine values (OR, 3.88; p = 0.02), and intraoperative blood loss (OR, 1.01; p = 0.04). Ruptured aorta (OR, 7.13; p = 0.02) and previous myocardial infarction (OR, 5.13; p = 0.04) were identified as independent risk factors for major postoperative morbidity. The postoperative survival of all patients at 5 years was 76.7% +/- 5%. After hospital discharge, the standardized mortality ratios showed no significant difference between hospital survivors and a comparable Japanese population and were 1.09 (p = 0.41) among patients without major morbidity and 1.82 (p = 0.12) among those with major morbidity. The development of renal failure requiring hemodialysis increased the risk of long-term death (hazard ratio, 5.59; p = 0.03), even among hospital survivors.Conclusions. Our approach for total arch replacement resulted in low in-hospital mortality and morbidity. Long-term outcomes are stable in hospital survivors, especially in the absence of a postoperative requirement for dialysis. (C) 2014 by The Society of Thoracic Surgeons