Abstract：
OBJECTIVE: To evaluate the impact of previous cardiac surgery (PCS) on clinical outcomes after reoperative extended arch repair for acute type A aortic dissection.
METHODS: This study included 37 acute type A aortic dissection patients with PCS (PCS group) and 992 without PCS (no-PCS group). Propensity score-matching yielded a subgroup of 36 pairs (1:1). In-hospital outcomes and mid-term survival were compared between the 2 groups.
RESULTS: The PCS group was older (56.7 ± 14.2 vs 52.2 ± 12.6 years, P = 0.036) and underwent a longer cardiopulmonary bypass (median, 212 vs 183 min, P < 0.001) compared with the no-PCS group. Operative death occurred in 88 (8.6%) patients, exhibiting no significant difference between groups (13.5% vs 8.4%, P = 0.237). Major postoperative morbidity was observed in 431 (41.9%) patients, also showing no difference between groups (45.9% vs 41.7%, P = 0.615). Moreover, the multivariable logistic regression analysis revealed that PCS was not significantly associated with operative mortality (adjusted odds ratio 2.58, 95% confidence interval 0.91-7.29, P = 0.075) or major morbidity (adjusted odds ratio 1.92, 95% confidence interval 0.88-4.18, P = 0.101). The 3-year cumulative survival rates were 71.1% for the PCS group and 83.9% for the no-PCS group (log-rank P = 0.071). Additionally, Cox regression indicated that PCS was not significantly associated with midterm mortality (adjusted hazard ratio 1.40, 95% confidence interval 0.44-4.41, P = 0.566). After matching, no significant differences were found between groups in terms of operative mortality (P > 0.999), major morbidity (P > 0.999) and midterm survival (P = 0.564).
CONCLUSIONS: No significant differences were found between acute type A aortic dissection patients with PCS and those without PCS regarding in-hospital outcomes and midterm survival after extended arch repair.
METHODS: This study included 37 acute type A aortic dissection patients with PCS (PCS group) and 992 without PCS (no-PCS group). Propensity score-matching yielded a subgroup of 36 pairs (1:1). In-hospital outcomes and mid-term survival were compared between the 2 groups.
RESULTS: The PCS group was older (56.7 ± 14.2 vs 52.2 ± 12.6 years, P = 0.036) and underwent a longer cardiopulmonary bypass (median, 212 vs 183 min, P < 0.001) compared with the no-PCS group. Operative death occurred in 88 (8.6%) patients, exhibiting no significant difference between groups (13.5% vs 8.4%, P = 0.237). Major postoperative morbidity was observed in 431 (41.9%) patients, also showing no difference between groups (45.9% vs 41.7%, P = 0.615). Moreover, the multivariable logistic regression analysis revealed that PCS was not significantly associated with operative mortality (adjusted odds ratio 2.58, 95% confidence interval 0.91-7.29, P = 0.075) or major morbidity (adjusted odds ratio 1.92, 95% confidence interval 0.88-4.18, P = 0.101). The 3-year cumulative survival rates were 71.1% for the PCS group and 83.9% for the no-PCS group (log-rank P = 0.071). Additionally, Cox regression indicated that PCS was not significantly associated with midterm mortality (adjusted hazard ratio 1.40, 95% confidence interval 0.44-4.41, P = 0.566). After matching, no significant differences were found between groups in terms of operative mortality (P > 0.999), major morbidity (P > 0.999) and midterm survival (P = 0.564).
CONCLUSIONS: No significant differences were found between acute type A aortic dissection patients with PCS and those without PCS regarding in-hospital outcomes and midterm survival after extended arch repair.
摘要：
目的：评估既往心脏手术（PCS）对急性A型主动脉夹层（ATAAD）再次手术扩大后的临床结局的影响。
方法：本研究包括37例ATAAD患者（PCS组）和992例无PCS（无PCS组）。倾向得分匹配产生了36对（1：1）的亚组。比较两组的住院结局和中期生存率。
结果：PCS组年龄较大（56.7±14.2vs52.2±12.6岁，p=0.036），并接受了更长的体外循环（中位数，212对183分钟，p<0.001）与无PCS组相比。手术死亡发生在88例（8.6%）患者中，组间无显著差异(13.5%vs8.4%，p=0.237）。主要术后发病率为431例（41.9%），组间也没有差异(45.9%vs41.7%，p=0.615）。此外，多变量逻辑回归分析显示,PCS与手术死亡率(校正比值比[OR]2.58,95%置信区间[CI]0.91-7.29,p=0.075)或主要发病率(校正OR1.92,95%CI0.88-4.18,p=0.101)无显著相关.PCS组的3年累积生存率为71.1％，非PCS组为83.9％（log-rankp=0.071）。此外,Cox回归分析显示，PCS与中期死亡率无显著相关性（校正风险比1.40，95%CI0.44-4.41，p=0.566）。匹配后,两组间手术死亡率无显著差异(p>0.999),主要发病率（p>0.999），和中期生存率（p=0.564）。
结论：有PCS的ATAAD患者和没有PCS的ATAAD患者在延长足弓修复后的住院结局和中期生存率方面没有显著差异。
方法：本研究包括37例ATAAD患者（PCS组）和992例无PCS（无PCS组）。倾向得分匹配产生了36对（1：1）的亚组。比较两组的住院结局和中期生存率。
结果：PCS组年龄较大（56.7±14.2vs52.2±12.6岁，p=0.036），并接受了更长的体外循环（中位数，212对183分钟，p<0.001）与无PCS组相比。手术死亡发生在88例（8.6%）患者中，组间无显著差异(13.5%vs8.4%，p=0.237）。主要术后发病率为431例（41.9%），组间也没有差异(45.9%vs41.7%，p=0.615）。此外，多变量逻辑回归分析显示,PCS与手术死亡率(校正比值比[OR]2.58,95%置信区间[CI]0.91-7.29,p=0.075)或主要发病率(校正OR1.92,95%CI0.88-4.18,p=0.101)无显著相关.PCS组的3年累积生存率为71.1％，非PCS组为83.9％（log-rankp=0.071）。此外,Cox回归分析显示，PCS与中期死亡率无显著相关性（校正风险比1.40，95%CI0.44-4.41，p=0.566）。匹配后,两组间手术死亡率无显著差异(p>0.999),主要发病率（p>0.999），和中期生存率（p=0.564）。
结论：有PCS的ATAAD患者和没有PCS的ATAAD患者在延长足弓修复后的住院结局和中期生存率方面没有显著差异。
