Impact of renal malperfusion on the perioperative and long-term outcome in patients with type A aortic dissection
10.3760/cma.j.issn.1001-4497.2018.11.002
- VernacularTitle:术前肾灌注不良对Stanford A型主动脉夹层围手术期及远期预后影响
- Author:
Kai ZHANG
1
;
Sichong QIAN
;
Songbo DONG
;
Xudong PAN
;
Sheng YANG
;
Shangdong XU
;
Jun ZHENG
;
Lizhong SUN
Author Information
1. 100029,首都医科大学附属北京安贞医院心外科 北京市心肺血管病研究所 北京市大血管疾病诊疗中心
- Keywords:
Aortic dissection;
Malperfusion;
Cardiac surgical procedures;
Renal ischaemia
- From:
Chinese Journal of Thoracic and Cardiovascular Surgery
2018;34(11):646-649
- CountryChina
- Language:Chinese
-
Abstract:
Objective To confirm the impact of renal malperfusion on early and late outcomes of patients undergoing sur-gery for type A aortic dissection(TAAD). Methods From June 2011 to July 2012,a total of 165 TAAD patients undergoing surgery in hospital were enrolled and divided into 2 groups based on the results:research group(complicated with renal malper-fusion),control group(without renal malperfusion). A cohort follow-up project was conducted among these patients. The pri-mary outcome was all-cause death. Baseline and operative characteristics,early and late outcomes were analyzed to assess difference between 2 groups. Cumlative survival rates within 72 months among the 2 groups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios(HR)and 95％ confidence intervals(95％ CI)of late mortality among the 2 groups. Results Renal malperfusion was detected in 38(23. 0％)of 165 TAAD patients. 30-day mortality was 15. 8％ and 3. 9％ in patients with and without renal malperfusion(P < 0. 05),respectively. The mean follow-up period was(67 ± 3)months,late survival was 68. 4％ in patients with renal malperfusion and 88. 2％ in patients without(P <0. 05). By Cox proportional hazards model,after adjusting forage,sex,group(acute or chronic),presence of cardiac tampon-ade,brachiocephalic vessels involvement,coronary arteries involvement,root replacement,total arch replacement,concomitant coronary artery bypass grafting(CABG)and other organ-malperfusion,when compared to the control group,the HR(95％ CI) of late mortality was 5. 18( 1. 07 - 5. 18)in the research group. Besides renal malperfusion,concomitant coronary artery bypass grafting was presented as an independent risk factor of long-term survival(HR = 10. 08,95％ CI:2. 28 - 44. 62,P = 0. 002). Conclusion Coexistence of renal malperfusion is associated with a substantially increased risk of death in patients undergoing surgery for TAAD. A more exact stratification that weight every malperfusion-affected organ but not base on the number of malp-erfusion-affected organ simply may be more helpful to TAAD patients with malperfusion syndrome.
