Mortality in Acute Type A Aortic Dissection: Validation of the Penn Classification
Mortality in Acute Type A Aortic Dissection: Validation of the Penn Classification
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DOI：
10.1016/j.athoracsur.2011.05.011
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发表时间：
2011-10-01
影响因子：
4.6
通讯作者：
Franco-Cereceda, Anders
中科院分区：
文献类型：
--
作者：
Olsson, Christian;Hillebrant, Carl-Gustaf;Franco-Cereceda, Anders
背景。急性 A 型夹层手术后的术中和院内死亡率很大程度上取决于术前条件，特别是局部或全身缺血的存在。最近，对急性 A 型主动脉夹层患者的 Penn 分类进行了描述。主要目的是验证 Penn 分类并调查与死亡率相关的术前变量。方法。 1990 年至 2009 年期间所有连续接受急性 A 型主动脉夹层手术的患者 (n = 360) 均纳入一项回顾性观察研究。使用单变量和多变量分析来确定与术中和院内死亡率相关的变量。倾向评分用于调整治疗选择偏倚。结果。术中总体死亡率为 7%（360 例中的 24 例），院内死亡率为 19%（360 例中的 69 例）。 219 名患者 (61%) 为 Penn Aa 级（14% 院内死亡率），51 名（14%）Ab 级患者（24% 死亡率），63 名（18%）Ac 级（24% 死亡率）和 27 名（8%）Abc 级（44% 死亡率），p = 0.007。在多变量分析中，Penn 级 Ac 和 Abc 与术中死亡独立相关（比值比分别为 5.0 和 5.4），Penn 级 Abc 和非 Aa 与院内死亡率独立相关（比值比分别为 3.4 和 2.3）。同时进行冠状动脉旁路移植术、年龄较大、DeBakey I 型夹层、长时间体外循环和低温停循环也与死亡率独立相关。结论。急性 A 型主动脉夹层的 Penn 分类是有目的的，鼓励继续使用。 Penn 分级表明局部或全身缺血与术中和院内死亡率独立相关。 (Ann Thorac Surg 2011;92:1376-83) (C) 2011，胸外科医师协会
Background. Intraoperative and in-hospital mortality after surgery for acute type A dissection depends largely on preoperative conditions, specifically the presence of localized or generalized ischemia. Recently, the Penn classification of patients with acute type A aortic dissection has been described. The primary aim was to validate the Penn classification and to investigate preoperative variables related to mortality.Methods. All consecutive patients operated for acute type A aortic dissection, 1990 to 2009 (n = 360), were included in a retrospective observational study. Univariate and multivariable analyses were used to identify variables related to intraoperative and in-hospital mortality. Propensity scoring was used to adjust for treatment selection bias.Results. Overall intraoperative mortality was 7% (24 of 360) and in-hospital mortality was 19% (69 of 360). Two hundred nineteen patients (61%) were Penn class Aa (14% in-hospital mortality), 51 (14%) class Ab (24% mortality), 63 (18%) class Ac (24% mortality), and 27 (8%) class Abc (44% mortality), p =0.007. In multivariable analysis, Penn class Ac and Abc were independently related to intraoperative death (odds ratio 5.0 and 5.4, respectively), and Penn class Abc and non-Aa were independently related to in-hospital mortality (odds ratio 3.4 and 2.3, respectively). Concomitant coronary artery bypass grafting, older age, DeBakey type I dissection, and prolonged periods of cardiopulmonary bypass and hypothermic circulatory arrest were also independently associated with mortality.Conclusions. The Penn classification of acute type A aortic dissection is purposeful and its continued usage encouraged. Penn class indicating localized or generalized ischemia is independently related to intraoperative and in-hospital mortality. (Ann Thorac Surg 2011;92:1376-83) (C) 2011 by The Society of Thoracic Surgeons