背景:急性A型主动脉夹层(ATAAD)是一种心血管急症,具有较高的死亡率和发病率。我们回顾性比较了在接受体外循环(CPB)治疗ATAAD的患者中,通过腋下动脉(AAC)进行单动脉插管与通过腋下和股动脉(DAC)进行双动脉插管对结果的影响。方法:2017年1月至2021年5月,对29例因ATAAD行主动脉弓修复术并停循环的患者分为AAC组(n=283)和DAC组(n=146)。进行倾向评分匹配(PSM)分析以比较各组的特征和结果。结果:PSM后(每组n=137),DAC组CPB持续时间较长(229vs244,p=0.011),主动脉阻断时间(121vs149,p<0.001),与AAC组相比,重症监护病房(ICU)住院时间(7vs8,p=0.014)和住院时间(19vs25,p<0.001)。透析的发生率(21%vs.31%,p=0.073),术后中风(9%对15%,p=0.143),ECMO支持(2%对7%,p=0.077),住院死亡率(7%和14%,p=0.071)和随访死亡率(10%vs19%,p=0.059)显示两组之间没有显着差异。多因素logistic回归分析显示,术后ECMO(OR:16.69,95%CI:1.78-156.29;p=0.014)或卒中(OR:11.34,95%CI:2.64-48.72;p<0.001)与住院死亡率相关。单变量Cox回归结果显示卒中病史(OR:4.61,95%CI:1.90-11.16;p=0.001),主动脉瓣成形术(OR:0.21,95%CI:0.07-0.59;p=0.003),术后ALT第1天(OR:1.00,95%CI:1.00-1.00;p=0.008),ECMO(OR:16.30,95%CI:4.78-55.61;p<0.001),气管切开术(OR:3.78,95%CI:1.08-13.20;p=0.037),术后卒中(OR:4.61,95%CI:1.90~11.16;p<0.001)和再次出血探查(OR:3.52,95%CI:1.01~12.27;p=0.048)与随访死亡率相关.结论:与双腋窝和股动脉相比,CPB用于ATAAD的手术治疗。单腋窝插管与CPB和ACC持续时间以及ICU和住院时间较短相关,但死亡率无显著差异.
Background: Acute type A aortic dissection (ATAAD) is a cardiovascular emergency and has high mortality and morbidity. We retrospectively compared the effects on outcomes of single arterial cannulation via
axillary artery (AAC) with double arterial cannulation via
axillary and femoral artery (DAC) in patients who underwent cardiopulmonary bypass (CPB) for ATAAD.Methods: Between January 2017 and May 2021, four hundred 29 patients who underwent aortic arch repair with circulatory arrest for ATAAD were divided into AAC group (n = 283) and DAC group (n = 146). The propensity score-matched (PSM) analysis were performed to compare the characteristics and outcomes of the groups.Results: After PSM (n = 137 in each), the DAC group had a longer duration of CPB (229 vs 244, p = 0.011), aortic cross-clamp time (121 vs 149, p < 0.001), durations of Intensive Care Unit (ICU) stay (7 vs 8, p = 0.014) and hospital stay (19 vs 25, p < 0.001) compared with AAC group. The incidences of dialysis (21% vs. 31%, p = 0.073), postoperative stroke (9% vs 15%, p = 0.143), ECMO support (2% vs 7%, p = 0.077), in-hospital mortality (7% vs 14%, p = 0.071) and follow-up mortality (10% vs 19%, p = 0.059) showed no significant difference between two groups. Multivariate logistic regression analysis showed postoperative ECMO (OR: 16.69, 95% CI: 1.78-156.29; p = 0.014) or stroke (OR: 11.34, 95% CI: 2.64-48.72; p < 0.001) were associated with in-hospital mortality. Univariate Cox regression results showed stroke history (OR: 4.61, 95% CI: 1.90-11.16; p = 0.001), aortic valvuloplasty (OR: 0.21, 95% CI: 0.07-0.59; p = 0.003), postoperative ALT day1 (OR: 1.00, 95% CI: 1.00-1.00; p = 0.008), ECMO (OR: 16.30, 95% CI: 4.78-55.61; p < 0.001), tracheotomy (OR: 3.78, 95% CI: 1.08-13.20; p = 0.037), postoperative stroke (OR: 4.61, 95% CI: 1.90-11.16; p < 0.001) and re-exploration for bleeding (OR: 3.52, 95% CI: 1.01-12.27; p = 0.048) were associated to follow-up mortality.Conclusions: For surgical treatment of ATAAD with CPB when compared to double
axillary and femoral artery, single
axillary cannulation was associated with shorter durations of CPB and ACC as well as ICU and hospital stays but no with significant difference in mortality.