背景:尽管外科技术取得了进展,急性A型主动脉夹层(ATAAD)修复后中风的发生率仍然很高,有大量的即时和长期不良后果,如死亡率上升,延长住院时间,和持续的神经损伤。管理ATAAD的复杂性超出了操作本身,突出了有关可修改的术前患者状况和围手术期麻醉管理策略的研究中的关键差距。
目的:本调查旨在阐明发病率,后果,急性A型主动脉夹层(ATAAD)手术干预后卒中的围手术期决定因素。
方法:在多中心回顾性分析中,对516例ATAAD手术患者进行了评估。数据包括人口统计信息,临床资料,手术方式,和结果。主要终点是术后卒中发生率,以住院死亡率和其他并发症为次要终点。
结果:术后卒中发生在13.6%的患者中(516人中有70人),并且与ICU的显着延长相关(中位数10vs.5天,P<0.001)和住院时间(中位数18vs.12天,P<0.001)。确定了以下关键的独立卒中危险因素:改良的虚弱指数(mFI)≥4(比值比[OR]:4.18,95%置信区间[CI]:1.24-14.1,P=0.021),颈总动脉灌注不良(OR:3.76,95%CI:1.23-11.44,P=0.02),体外循环(CPB)前低血压(平均动脉压≤50mmHg;OR:2.17,95%CI:1.06-4.44,P=0.035),术中局部脑氧饱和度(rSO2)降低≥20%(OR:1.93,95%CI:1.02-3.64,P=0.042),CPB后血管活性-正性肌力评分(VIS)≥10(OR:2.24,95%CI:1.21-4.14,P=0.01)。
结论:ATAAD手术患者术后卒中显著增加ICU和住院时间。这些发现强调了识别和减轻主要风险的迫切需要,如高mFI,颈总动脉灌注不良,CPB前低血压,显著的大脑rSO2减少,和高架CPB后VIS,改善预后并降低卒中患病率。
背景:泰国临床试验注册(TCTR20230615002)。日期为2023年6月15日。追溯登记。
BACKGROUND: Despite advances in surgical techniques, the incidence of stroke following acute type A aortic dissection (ATAAD) repair remains markedly high, with substantial immediate and long-term adverse outcomes such as elevated mortality, extended hospital stays, and persistent neurological impairments. The complexity of managing ATAAD extends beyond the operation itself, highlighting a crucial gap in research concerning modifiable preoperative patient conditions and perioperative anesthetic management strategies.
OBJECTIVE: This investigation aimed to elucidate the incidence, consequences, and perioperative determinants of stroke following surgical intervention for acute type A aortic dissection (ATAAD).
METHODS: In a multicenter retrospective analysis, 516 ATAAD surgery patients were evaluated. The data included demographic information, clinical profiles, surgical modalities, and outcomes. The primary endpoint was postoperative stroke incidence, with hospital mortality and other complications serving as secondary endpoints.
RESULTS: Postoperative stroke occurred in 13.6% of patients (70 out of 516) and was associated with significant extension of the ICU (median 10 vs. 5 days, P < 0.001) and hospital stay (median 18 vs. 12 days, P < 0.001). The following key independent stroke risk factors were identified: modified Frailty Index (mFI) ≥ 4 (odds ratio [OR]: 4.18, 95% confidence interval [CI]: 1.24-14.1, P = 0.021), common carotid artery malperfusion (OR: 3.76, 95% CI: 1.23-11.44, P = 0.02), pre-cardiopulmonary bypass (CPB) hypotension (mean arterial pressure ≤ 50 mmHg; OR: 2.17, 95% CI: 1.06-4.44, P = 0.035), ≥ 20% intraoperative decrease in cerebral regional oxygen saturation (rSO2) (OR: 1.93, 95% CI: 1.02-3.64, P = 0.042), and post-CPB vasoactive-inotropic score (VIS) ≥ 10 (OR: 2.24, 95% CI: 1.21-4.14, P = 0.01).
CONCLUSIONS: Postoperative stroke significantly increases ICU and hospital durations in ATAAD surgery patients. These findings highlight the critical need to identify and mitigate major risks, such as high mFI, common carotid artery malperfusion, pre-CPB hypotension, significant cerebral rSO2 reductions, and elevated post-CPB VIS, to improve outcomes and reduce stroke prevalence.
BACKGROUND: Thai Clinical Trials Registry (TCTR20230615002). Date registered on June 15, 2023. Retrospectively registered.