Is extended arch replacement for acute type A aortic dissection an additional risk factor for mortality?

被引:40
|
作者
Tan, MESH
Dossche, KME
Morshuis, WJ
Kelder, JC
Waanders, FGJ
Schepens, MAAM
机构
[1] St Antonius Hosp, Dept Cardiothorac Surg, NL-3435 CM Nieuwegein, Netherlands
[2] St Antonius Hosp, Dept Cardiol Res & Stat Anal, NL-3435 CM Nieuwegein, Netherlands
[3] St Antonius Hosp, Dept Clin Perfus, NL-3435 CM Nieuwegein, Netherlands
来源
ANNALS OF THORACIC SURGERY | 2003年 / 76卷 / 04期
关键词
D O I
10.1016/S0003-4975(03)00726-4
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background. We report our experience with surgery for acute type A aortic dissection with involvement of the aortic arch. Methods. From January 1986 to December 2001, 277 patients underwent surgery for acute type A aortic dissection. In 70 patients (25.3%), surgery was extended into the aortic arch: hemiarch and total arch replacement in 53 (75.7%) and 17 (24.3%) patients, respectively. Deep hypothermic circulatory arrest was used in 19 patients, antegrade selective cerebral perfusion in 38, and combined deep hypothermic circulatory arrest with antegrade selective cerebral perfusion in 13. Results. Operative mortality was 18.6% (13/70) after extended replacement into the arch versus 21.7% (45/207) after surgery limited to the ascending aorta (p = 0.62). Multivariate analysis did not reveal significant risk factors for operative mortality. Postoperatively, 5 patients (8.1%) had a new postoperative cerebral vascular accident (CVA).Multivariate analysis showed an earlier date of operation as the only independant determinant for a new postoperative CVA (p = 0.0162, RR = 0.80/year, 95% Cl = 0.67 to 0.96). None of the patients, operated on with antegrade selective cerebral perfusion, had a new cerebral deficit. Comparing the different methods of cerebral protection, multivariate risk analysis revealed antegrade selective cerebral perfusion as a significant protective factor against new postoperative CVA (p = 0.0110, OR = 0.12, 95% Cl = 0.02 to 0.61). Survival at 5 and 10 years was 66.6.5% and 40.0%, respectively, after replacement of the aortic arch versus 68.7% and 57.7%, respectively, after replacement of the ascending aorta (p = 0.96). Freedom from aortic arch reoperation was 96.3% at 5 and 77.0% at 10 years versus 86.6% and 75.1% in both groups, respectively (p = 0.21). Conclusions. Extended replacement into the aortic arch during surgery for acute type A dissection does not influence early and late results. The best cerebral protection seems to be obtained with antegrade selective cerebral perfusion.
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收藏
页码:1209 / 1214
页数:6
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