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.
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。