Khirurgiia · 2019
[Risk factors of surgical treatment of acute aortic dissection type A (in Russian only)].
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Latt K K, Vasiliyev K N, Bayandin N L, Stupin V A
Аннотация
AIM: To evaluate risk factors of surgical treatment of acute aortic dissection type A.
MATERIAL AND METHODS: Retrospective analysis included 100 patients with acute aortic dissection type A who underwent surgery in 2007-2017. Patients were divided into 2 groups: group I (survivors, n=79) and group II (unfavorable outcomes, n=21).
RESULTS: Postoperative in-hospital mortality was 21% (21/100). Preoperative risk factors were cardiac tamponade (p=0.0001), aortic rupture (p=0.0001), impaired coronary blood flow (p=0.0001), renal malperfusion (p=0.0001). Prolonged cardiopulmonary bypass (156.1±37.9 min vs 205.7±91.2 min), surgery time (5.0±1.1 vs. 6.8±2.5 h, p=0.0009) and deep hypothermia (26.1±4.6 min vs 22.4±4.4 min) were the main intraoperative risk factors influencing surgical outcomes in patients who underwent aortic arch repair. Multiple organ failure (p=0.0001), sepsis (p=0.0007), severe postoperative bleeding (p=0.0010) and disseminated intravascular coagulation (p=0.0001) were the main predictors of advanced mortality in postoperative period.
CONCLUSION: Timely surgical treatment in case of cardiac tamponade and aortic rupture is essential to improve survival in patients with acute aortic dissection. Advanced aortic repair including hemi- or total arch replacement should be comprehensively measured because such procedures may be followed by increased postoperative morbidity and mortality after emergency aortic surgery.
MATERIAL AND METHODS: Retrospective analysis included 100 patients with acute aortic dissection type A who underwent surgery in 2007-2017. Patients were divided into 2 groups: group I (survivors, n=79) and group II (unfavorable outcomes, n=21).
RESULTS: Postoperative in-hospital mortality was 21% (21/100). Preoperative risk factors were cardiac tamponade (p=0.0001), aortic rupture (p=0.0001), impaired coronary blood flow (p=0.0001), renal malperfusion (p=0.0001). Prolonged cardiopulmonary bypass (156.1±37.9 min vs 205.7±91.2 min), surgery time (5.0±1.1 vs. 6.8±2.5 h, p=0.0009) and deep hypothermia (26.1±4.6 min vs 22.4±4.4 min) were the main intraoperative risk factors influencing surgical outcomes in patients who underwent aortic arch repair. Multiple organ failure (p=0.0001), sepsis (p=0.0007), severe postoperative bleeding (p=0.0010) and disseminated intravascular coagulation (p=0.0001) were the main predictors of advanced mortality in postoperative period.
CONCLUSION: Timely surgical treatment in case of cardiac tamponade and aortic rupture is essential to improve survival in patients with acute aortic dissection. Advanced aortic repair including hemi- or total arch replacement should be comprehensively measured because such procedures may be followed by increased postoperative morbidity and mortality after emergency aortic surgery.