Sorasicha Nithikasem, Abhishek Chakraborty, Hirohisa Ikegami, Manabu Takebe, Gengo Sunagawa, Antonio Chiricolo, Ashok Chaudhary, Alexander Rahimi, Simran Agarwala, Mark Russo, Leonard Y Lee, Anthony Lemaire
{"title":"因 A 型膜内血肿或 A 型主动脉夹层而接受急诊手术的患者,其预后相似。","authors":"Sorasicha Nithikasem, Abhishek Chakraborty, Hirohisa Ikegami, Manabu Takebe, Gengo Sunagawa, Antonio Chiricolo, Ashok Chaudhary, Alexander Rahimi, Simran Agarwala, Mark Russo, Leonard Y Lee, Anthony Lemaire","doi":"10.1186/s13019-024-03101-2","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.</p><p><strong>Methods: </strong>This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.</p><p><strong>Results: </strong>A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.</p><p><strong>Conclusions: </strong>Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. 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引用次数: 0
摘要
目的:室壁内血肿和主动脉夹层都是急性主动脉综合征,尽管病理过程存在主要差异,但两者都采用类似的手术技术进行修复。本研究旨在确定壁内血肿患者与主动脉夹层患者接受升主动脉弓修补术的手术效果差异:这项对前瞻性收集数据的回顾性研究纳入了2018年1月至2023年5月期间在一家学术机构接受急诊升主动脉弓或主动脉弓修复术的所有急性壁内血肿或A型主动脉夹层患者。主要结果包括术中死亡率、30 天死亡率和术后住院时间。次要结果包括术后并发症。结果采用Chi-squared、Fisher's Exact和t检验进行分析,显著性设定为p 结果:共纳入 107 例患者,其中 27 例(25%)有壁内血肿,80 例(75%)有 A 型主动脉夹层。术前特征(如年龄、性别和合并症)无差异,围手术期特征(如病例长度、心肺旁路、主动脉交叉钳夹和循环停止时间)也无差异。在比较术后结果时,与主动脉夹层队列相比,室壁内血肿队列术后需要开心包窗的心包积液率更高(15% [n = 4] vs. 3% [n = 2];P = 0.02)。术中死亡率、30 天死亡率和术后住院时间等其他主要结果没有差异。术后并发症的发生率也没有差异,如需要再次手术的出血、脑血管意外、心房颤动、需要胸腔穿刺的胸腔积液以及手术相关的急诊就诊率:我们的分析表明,室壁内血肿和 A 型主动脉夹层患者接受升主动脉弓修补术的结果相似。尽管室壁内血肿队列中术后需要开心包窗的比例较高,但总体主要结果仍具有可比性。这些发现更好地阐明了对急性壁内血肿患者进行主动脉弓升部修补术的护理标准。
Patients undergoing emergent surgery for type A intramural hematomas or type A aortic dissections have similar outcomes.
Objective: Despite key differences in pathological processes, both Intramural Hematomas and Aortic Dissections are Acute Aortic Syndromes repaired with similar surgical technique. The objective of this study was to determine differences in surgical outcomes between patients with Intramural Hematoma versus Type A Aortic Dissection undergoing Ascending Aortic Arch repair.
Methods: This retrospective review of prospectively collected data included all patients with acute Intramural Hematoma or Type A Aortic Dissection who underwent emergent Ascending- or Arch Repair from January 2018 to May 2023 at a single academic institution. Primary outcomes included intraoperative mortality, 30-Day mortality, and postoperative stay. Secondary outcomes included postoperative complications. Outcomes were analyzed using Chi-squared, Fisher's Exact, and t-tests, with significance set at p < 0.05.
Results: A total of 107 patients were included, 27 of whom (25%) had Intramural Hematoma and 80 (75%) had Type A Aortic Dissection. There were no differences in preoperative characteristics such as age, gender, and comorbidities, and no differences in perioperative characteristics such as case length, cardiopulmonary bypass, aortic cross-clamp, and circulatory arrest times. When comparing postoperative outcomes, there was a higher rate of postoperative pericardial effusions requiring pericardial window in the Intramural Hematoma cohort compared to the Aortic Dissection cohort (15% [n = 4] vs. 3% [n = 2]; p = 0.02). There were no differences in other primary outcomes such as intraoperative mortality, 30-Day mortality, and postoperative length of stay. There were also no differences in the rates of postoperative complications such as bleeding requiring reoperation, cerebrovascular accident, atrial fibrillation, pleural effusion requiring thoracentesis, and surgery-related Emergency Department visits.
Conclusions: Our analysis demonstrates similar outcomes for patients undergoing Ascending Aortic Arch repair between patients with Intramural Hematoma and Type A Aortic Dissection. Despite the higher rate of required postoperative pericardial windows in the Intramural Hematoma cohort, the overall primary outcomes remained comparable. These findings better elucidate the standard of care for patients with acute Intramural Hematoma undergoing Ascending Aortic Arch repair.
期刊介绍:
Journal of Cardiothoracic Surgery is an open access journal that encompasses all aspects of research in the field of Cardiology, and Cardiothoracic and Vascular Surgery. The journal publishes original scientific research documenting clinical and experimental advances in cardiac, vascular and thoracic surgery, and related fields.
Topics of interest include surgical techniques, survival rates, surgical complications and their outcomes; along with basic sciences, pediatric conditions, transplantations and clinical trials.
Journal of Cardiothoracic Surgery is of interest to cardiothoracic and vascular surgeons, cardiothoracic anaesthesiologists, cardiologists, chest physicians, and allied health professionals.