目的:急性A型主动脉夹层(AADA)是一种危及生命的医疗紧急情况。紧急手术修复是金标准,但死亡率仍然很高。病情恶化到医院的病人死亡率更高,尤其是心肺复苏(CPR)后。本研究旨在分析接受AADA手术并需要术前CPR的患者的预后。
方法:在2000年至2023年之间,810名患者在我们中心接受了AADA紧急手术。其中,63例进行了术前CPR。我们进行了回顾性分析和随访。
结果:平均年龄为64±13岁,男性患者37例(59%)。Further,50例(79%)患者术前插管,和54(86%)有心包积液。24(38%)患者进行了院外CPR,19(30%)在医院需要CPR,20(32%)在手术室需要CPR。41例(65%)患者成功实现了心肺复苏,恢复了自主循环,22例(35%)在正在进行的CPR下接受了紧急手术.心肺复苏的中位时间为10(四分位距12)分钟,从症状出现到手术开始的中位时间为5.5(四分位距4.8)h。大多数患者接受了升主动脉置换术和半支弓修复(n=37,59%)。Further,26例(41%)患者行完全牙根置换。另有15例(24%)患者接受了带或不带(冷冻)象鼻修复的全足弓修复。8例(13%)患者出现术后卒中。30天死亡率为29(46%)。术前插管患者的30天死亡率并没有显着升高(n=15/28,54%,P=0.446)。1-,全组5年和10年生存率分别为42%、39%和36%。
结论:接受AADA手术并进行术前CPR的患者的早期死亡率极高(近50%)。然而,这意味着即使术前预后不良,50%的患者也能从手术中获益。CPR后术前插管且神经系统状况不明的患者也应接受手术。在AADA的初始手术中存活的患者具有可接受的长期存活。无论术前情况如何,所有AADA患者都应进行紧急手术。即使在心肺复苏后。
OBJECTIVE: Acute aortic dissection type A (AADA) is a life-threatening medical emergency. Emergent surgical repair is the gold standard but mortality remains high. Mortality is even higher in patients who arrive at the hospital in poor condition, especially after cardiopulmonary resuscitation (CPR). This study was designed to analyse the outcome of patients who underwent surgery for AADA and who require preoperative CPR.
METHODS: Between 2000 and 2023, 810 patients underwent emergent surgery for AADA at our centre. Of these, 63 had preoperative CPR. We performed a retrospective analysis with follow-up.
RESULTS: Mean age was 64 ± 13 years and 37 (59%) patients were male. Further, 50 (79%) patients had preoperative intubation, and 54 (86%) had pericardial effusion. Twenty-four (38%) patients had out-of-hospital CPR, 19 (30%) required CPR in hospital and 20 (32%) needed CPR in the operating room. Successful CPR with return of spontaneous circulation was achieved in 41 (65%) patients, and 22 (35%) underwent emergent surgery under ongoing CPR. The median time of CPR was 10 (interquartile range 12) min, and the median time from onset of symptoms to start of the operation was 5.5 (interquartile range 4.8) h. The majority of patients underwent ascending aortic replacement with hemiarch repair (n = 37, 59%). Further, 26 (41%) patients underwent full root replacement. Another 15 (24%) patients underwent total arch repair with or without (frozen) elephant trunk repair. Postoperative stroke was present in 8 (13%) patients. The 30-day mortality was 29 (46%). The 30-day mortality of patients with preoperative intubation was not significantly higher (n = 15/28, 54%, P = 0.446). The 1-, 5- and 10-year survival rates of the entire group were 42, 39 and 36%.
CONCLUSIONS: Early mortality for patients undergoing surgery for AADA with preoperative CPR is extremely high (almost 50%). However, this means that also ∼50% of patients benefit from surgery despite poor preoperative prognosis. Patients with preoperative intubation after CPR and unknown neurological condition should also undergo surgery. Patients who survive the initial operation for AADA have acceptable long-term survival. Emergent surgery should be offered for all patients with AADA regardless of the preoperative condition, even after CPR.