PDF(Pubmed)
Abstract：
BACKGROUND: Acute type A aortic dissection (ATAAD) continues to be a subject of active research due to its high mortality rates and associated complications. Cerebral malperfusion in ATAAD can have a devastating impact on patients\' neurological function and overall quality of life. We aimed to explore the risk profile and prognosis in ATAAD patients presenting with preoperative imaging signs of cerebral malperfusion (PSCM).
METHODS: We obtained patient data from our Aortic Dissection Registry, which included 480 consecutive ATAAD cases who underwent surgical repair between 2001 and 2021. Primary endpoint outcomes included the in-hospital and 30-day mortality, postoperative new neurological deficit, mechanical ventilation hours, and intensive care unit (ICU) length of stay.
RESULTS: Of the total cohort, 82 patients (17.1%) had PSCM. Both groups had similar distributions in terms of age, sex, and body mass index. The patients in the PSCM group presented with a higher logistic EuroSCORE (47, IQR [31, 64] vs. 24, IQR [15, 39]; p < 0.001) and a higher portion of patients with a previous cardiac surgery (7.3% vs. 2.0%; p = 0.020). Intraoperatively, the bypass, cardioplegia, and aortic cross-clamp times were similar between both groups. However, the patients in the PSCM group received significantly more intraoperative packed red blood cells, fresh frozen plasma, and platelets transfusions (p < 0.05). Following the surgery, the patients who presented with PSCM had markedly longer ventilation hours (108.5 h, IQR [44, 277] vs. 43 h, IQR [16, 158], p < 0.001) and a significantly longer ICU length of stay (7 days, IQR [4, 13] vs. 5 days, IQR [2, 11]; p = 0.013). Additionally, the patients with PSCM had significantly higher rates of postoperative new neurological deficits (35.4% vs. 19.4%; p = 0.002). In the Cox regression analysis, PSCM was associated with significantly poorer long-term survival (hazard ratio (HR) 1.75, 95%CI [1.20-2.53], p = 0.003). Surprisingly, hypertension was shown as a protective factor against long-term mortality (HR: 0.59, 95%CI [0.43-0.82], p = 0.001).
CONCLUSIONS: PSCM in ATAAD patients is linked to worse postoperative outcomes and poorer long-term survival, emphasizing the need for early recognition and tailored management.
METHODS: We obtained patient data from our Aortic Dissection Registry, which included 480 consecutive ATAAD cases who underwent surgical repair between 2001 and 2021. Primary endpoint outcomes included the in-hospital and 30-day mortality, postoperative new neurological deficit, mechanical ventilation hours, and intensive care unit (ICU) length of stay.
RESULTS: Of the total cohort, 82 patients (17.1%) had PSCM. Both groups had similar distributions in terms of age, sex, and body mass index. The patients in the PSCM group presented with a higher logistic EuroSCORE (47, IQR [31, 64] vs. 24, IQR [15, 39]; p < 0.001) and a higher portion of patients with a previous cardiac surgery (7.3% vs. 2.0%; p = 0.020). Intraoperatively, the bypass, cardioplegia, and aortic cross-clamp times were similar between both groups. However, the patients in the PSCM group received significantly more intraoperative packed red blood cells, fresh frozen plasma, and platelets transfusions (p < 0.05). Following the surgery, the patients who presented with PSCM had markedly longer ventilation hours (108.5 h, IQR [44, 277] vs. 43 h, IQR [16, 158], p < 0.001) and a significantly longer ICU length of stay (7 days, IQR [4, 13] vs. 5 days, IQR [2, 11]; p = 0.013). Additionally, the patients with PSCM had significantly higher rates of postoperative new neurological deficits (35.4% vs. 19.4%; p = 0.002). In the Cox regression analysis, PSCM was associated with significantly poorer long-term survival (hazard ratio (HR) 1.75, 95%CI [1.20-2.53], p = 0.003). Surprisingly, hypertension was shown as a protective factor against long-term mortality (HR: 0.59, 95%CI [0.43-0.82], p = 0.001).
CONCLUSIONS: PSCM in ATAAD patients is linked to worse postoperative outcomes and poorer long-term survival, emphasizing the need for early recognition and tailored management.
摘要：
背景：急性A型主动脉夹层（ATAAD）由于其高死亡率和相关并发症，仍然是活跃研究的主题。ATAAD患者的脑灌注不良会对患者的神经功能和整体生活质量产生破坏性影响。我们旨在探讨具有脑灌注不良（PSCM）术前影像学征象的ATAAD患者的风险状况和预后。
方法：我们从主动脉夹层登记处获得患者数据，其中包括2001年至2021年间接受手术修复的480例连续ATAAD病例。主要终点结果包括住院和30天死亡率，术后新的神经功能缺损，机械通气小时数,和重症监护病房(ICU)住院时间。
结果：在总队列中，82例患者（17.1%）有PSCM。两组的年龄分布相似，性别,和体重指数。PSCM组患者的LogisticEuroSCORE较高（47，IQR[31，64]与24，IQR[15，39]；p<0.001）和先前进行过心脏手术的患者比例较高（7.3％vs.2.0%；p=0.020）。术中,旁路，心脏停搏液,两组的主动脉阻断时间相似.然而,PSCM组的患者接受了更多的术中红细胞，新鲜冷冻血浆，和血小板输注(p<0.05)。手术后,接受PSCM的患者的通气时间明显更长（108.5小时，IQR[44,277]vs.43h,IQR[16,158],p<0.001）和明显更长的ICU住院时间（7天，IQR[4,13]vs.5天,IQR[2,11];p=0.013)。此外,PSCM患者术后新发神经功能缺损的发生率明显较高(35.4%vs.19.4%；p=0.002）。在Cox回归分析中，PSCM与显著较差的长期生存率相关(风险比(HR)1.75,95CI[1.20-2.53],p=0.003)。令人惊讶的是,高血压被证明是长期死亡率的保护因素(HR：0.59,95CI[0.43-0.82]，p=0.001)。
结论：ATAAD患者的PSCM与更差的术后预后和更差的长期生存率有关。强调需要早期识别和量身定制的管理。
方法：我们从主动脉夹层登记处获得患者数据，其中包括2001年至2021年间接受手术修复的480例连续ATAAD病例。主要终点结果包括住院和30天死亡率，术后新的神经功能缺损，机械通气小时数,和重症监护病房(ICU)住院时间。
结果：在总队列中，82例患者（17.1%）有PSCM。两组的年龄分布相似，性别,和体重指数。PSCM组患者的LogisticEuroSCORE较高（47，IQR[31，64]与24，IQR[15，39]；p<0.001）和先前进行过心脏手术的患者比例较高（7.3％vs.2.0%；p=0.020）。术中,旁路，心脏停搏液,两组的主动脉阻断时间相似.然而,PSCM组的患者接受了更多的术中红细胞，新鲜冷冻血浆，和血小板输注(p<0.05)。手术后,接受PSCM的患者的通气时间明显更长（108.5小时，IQR[44,277]vs.43h,IQR[16,158],p<0.001）和明显更长的ICU住院时间（7天，IQR[4,13]vs.5天,IQR[2,11];p=0.013)。此外,PSCM患者术后新发神经功能缺损的发生率明显较高(35.4%vs.19.4%；p=0.002）。在Cox回归分析中，PSCM与显著较差的长期生存率相关(风险比(HR)1.75,95CI[1.20-2.53],p=0.003)。令人惊讶的是,高血压被证明是长期死亡率的保护因素(HR：0.59,95CI[0.43-0.82]，p=0.001)。
结论：ATAAD患者的PSCM与更差的术后预后和更差的长期生存率有关。强调需要早期识别和量身定制的管理。
