The results of aortic arch replacement using antegrade cerebral perfusion in haemodialysis patients: analysis of the Japan cardiovascular surgery database
The results of aortic arch replacement using antegrade cerebral perfusion in haemodialysis patients: analysis of the Japan cardiovascular surgery database
复制标题
血液透析患者顺行脑灌注主动脉弓置换术的结果：日本心血管外科数据库分析
DOI：
10.1093/ejcts/ezab252
复制
发表时间：
2021
影响因子：
3.4
通讯作者：
Motomura Noboru
中科院分区：
文献类型：
--
作者：
Saito Yoshiaki;Yamamoto Hiroyuki;Fukuda Ikuo;Miyata Hiroaki;Minakawa Masahito;Motomura Noboru
关于透析患者主动脉弓置换术的数据有限。本研究的目的是检查真实世界的数据，并确定术前透析状态和其他风险对使用日本心血管外科数据库进行手术主动脉弓置换术的影响。方法2014-2017年期间，共有5044例患者接受了顺行脑灌注的选择性隔离主动脉弓置换术，符合研究条件。其中，89例患者在术前接受了血液透析。根据术前估计的肾小球滤过率和透析状态将患者分为6组进行比较。采用多变量回归模型对术前和术后数据进行分析。非慢性肾脏病（CKD）的总体手术死亡率（估计肾小球滤过率>60 ml/min/1.73 m2）、3A期、3B期、4期、5期CKD和透析患者分别为2.6%、3.1%、6.8%、11.6%、16.7%和13.5%，分别风险调整后，与非CKD组相比，透析与手术死亡率密切相关（比值比4.39和95%置信区间2.22-8.72），并有与术后卒中相关的趋势（比值比2.02，95%置信区间1.00- 4.10，P = 0.051）。作为死亡率的预测因素，男性，外周动脉疾病，术前肝功能障碍和左心室功能受损被identified. CONCLUSIONSSThe日本全国数据库显示的结果主动脉弓置换术在透析患者。应考虑为具有多种死亡风险的此类患者提供适当的咨询和替代策略。
OBJECTIVESThere have been limited data available regarding aortic arch replacement in dialysis patients. The purpose of this study was to examine real-world data and to determine the impact of preoperative dialysis status and other risks on surgical aortic arch replacement using the Japan Cardiovascular Surgery Database.METHODSA total of 5044 patients who underwent elective, isolated aortic arch replacement using antegrade cerebral perfusion during 2014–2017 were eligible for the study. Of these, 89 patients received haemodialysis preoperatively. The patients were divided into 6 groups according to their preoperative estimated glomerular filtration rate and dialysis status for comparison. Preoperative and postoperative data were examined using a multivariable regression model.RESULTSThe overall surgical mortality rates of non-Chronic Kidney Disease (CKD) (estimated glomerular filtration rate >60 ml/min/1.73 m2), stage 3A, stage 3B, stage 4, stage 5 CKD and dialysis patients were 2.6%, 3.1%, 6.8%, 11.6%, 16.7% and 13.5%, respectively. After risk adjustment, dialysis was shown to be strongly associated with surgical mortality (odds ratio 4.39 and 95% confidence interval 2.22–8.72) and have a trend to be associated with postoperative stroke (odds ratio 2.02, 95% confidence interval 1.00–4.10,P= 0.051) when compared to the non-CKD group. As predictors of mortality, male sex, peripheral arterial disease, preoperative liver dysfunction and impaired left ventricular function were identified.CONCLUSIONSThe Japanese nationwide database revealed the outcomes of aortic arch replacement in dialysis patients. Appropriate counselling and an alternative strategy should be considered for such patients with multiple risks for mortality.