Influencing factors for postoperative short-term mortality in patients with acute Stanford type A aortic dissection

doi:10.3877/cma.j.issn.2096-1537.2022.01.004

Abstract

Abstract:

Objective

To investigate the influencing factors of postoperative short-term mortality in patients with acute Stanford type A aortic dissection (ASTAAD).

Methods

The clinical data of 253 ASTAAD patients with 213 (84.19%) of male, who was admitted in the First Affiliated Hospital of Xinjiang Medical University from January 2017 to January 2021 in our department, had been retrospectively collected. The age was (47.07±9.27) years. Patients were divided into survivor (216 patients, 85.38%) and death (37 patients, 14.62%) by the short-term outcome of post-operation. Baseline characteristics and perioperative clinical data were analyzed, univariate and multivariate logistic regression was performed for exploring the influencing factors of short-term mortality in patients with ASTAAD.

Results

Univariate analysis showed that there were statistically significant differences between the two groups (P＜0.05) in age, preoperative hypoperfusion syndrome, cardiopulmonary bypass (CPB) time, more than 1 L of drainage volume in 48 hours after surgery, postoperative acute kidney injury treated with renal replacement therapy (RRT-AKI) and postoperative low cardiac output syndrome (LCOS). Multivariate logistic regression analysis showed that age [odds ratio (OR)=1.174, 95% confidence interval (95%CI)=1.083-1.272, P＜0.001], preoperative hypoperfusion syndrome (OR=7.339, 95%CI: 2.221-24.247, P=0.001), CPB time (OR=1.031, 95%CI: 1.015-1.048, P＜0.001), postoperative RRT-AKI (OR=12.490, 95%CI: 3.477-44.866, P＜0.001), postoperative LCOS (OR=14.325,95%CI: 2.740-74.897, P=0.002) were the independent influencing factors of short-term mortality of postoperative ATAAD patients.

Conclusion

There is high mortality in postoperative ATAAD patients. The age, preoperative hypoperfusion syndrome, CPB time, postoperative RRT-AKI, postoperative LCOS are the independent influencing factors of short-term mortality of postoperative ATAAD patients.

Key words: Aortic dissection, acute Stanford type A, Short-term mortality, Postoperative mortality

Wangtao Zhou, Xiangyou Yu, Julaiti·Rouzhahong, Ju Guo, Ying Li, Yunlin Song. Influencing factors for postoperative short-term mortality in patients with acute Stanford type A aortic dissection[J]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2022, 08(01): 31-36.

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URL: https://icu.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2096-1537.2022.01.004

https://icu.cma-cmc.com.cn/EN/Y2022/V08/I01/31

Figures/Tables 4

资料	存活组（216例）	死亡组（37例）	统计值	P值
基线资料
性别［例（%）］				χ²=3.525	0.060
	男	178（82.41）	35（94.59）
	女	38（17.59）	2（5.41）
年龄（岁， $x ¯$ ±s）		45.96±9.12	53.51±7.47	t=4.769	0.001
体质量指数（kg/m²， $x ¯$ ±s）		25.73±4.42	25.95±4.22	t=0.275	0.784
合并高血压［例（%）］		150（69.44）	30（81.08）	χ²=2.084	0.149
合并糖尿病［例（%）］		12（5.56）	4（10.81）	χ²=1.473	0.225
术前资料
发病至就诊时间［h，M（Q₂₅，Q₇₅）］		24（15，72）	24（24，38）	Z=0.097	0.923
术前准备时间［h，M（Q₂₅，Q₇₅）］		21（12，37）	21（11，24）	Z=0.618	0.537
主动脉瓣关闭不全［例（%）］		98（45.40）	13（35.10）	χ²=1.344	0.246
伴器官灌注不良综合征［例（%）］				χ²=11.204	0.001
	神经系统损伤	12（5.56）	4（10.81）
	冠脉累及	10（4.63）	8（21.62）
	肠系膜受累	6（2.78）	6（16.22）
	肢体受累	8（3.70）	2（5.41）
	肾动脉累及	10（4.63）	5（13.51）
白细胞计数（×10⁹/L， $x ¯$ ±s）		10.91±3.06	12.05±3.73	t=1.759	0.080

资料	存活组（216例）	死亡组（37例）	统计值	P值
基线资料
性别［例（%）］				χ²=3.525	0.060
	男	178（82.41）	35（94.59）
	女	38（17.59）	2（5.41）
年龄（岁， $x ¯$ ±s）		45.96±9.12	53.51±7.47	t=4.769	0.001
体质量指数（kg/m²， $x ¯$ ±s）		25.73±4.42	25.95±4.22	t=0.275	0.784
合并高血压［例（%）］		150（69.44）	30（81.08）	χ²=2.084	0.149
合并糖尿病［例（%）］		12（5.56）	4（10.81）	χ²=1.473	0.225
术前资料
发病至就诊时间［h，M（Q₂₅，Q₇₅）］		24（15，72）	24（24，38）	Z=0.097	0.923
术前准备时间［h，M（Q₂₅，Q₇₅）］		21（12，37）	21（11，24）	Z=0.618	0.537
主动脉瓣关闭不全［例（%）］		98（45.40）	13（35.10）	χ²=1.344	0.246
伴器官灌注不良综合征［例（%）］				χ²=11.204	0.001
	神经系统损伤	12（5.56）	4（10.81）
	冠脉累及	10（4.63）	8（21.62）
	肠系膜受累	6（2.78）	6（16.22）
	肢体受累	8（3.70）	2（5.41）
	肾动脉累及	10（4.63）	5（13.51）
白细胞计数（×10⁹/L， $x ¯$ ±s）		10.91±3.06	12.05±3.73	t=1.759	0.080

术中资料	存活组（216例）	死亡组（37例）	统计值	P值
手术方式［例（%）］			χ²=3.521	0.061
孙氏	116（53.7）	26（70.3）
非孙氏	100（46.3）	11（29.7）
手术时间（min）	395.73±92.82	463.51±57.30	t=5.977	0.001
体外循环时间（min）	161.57±44.86	184.97±26.62	t=4.087	0.001
主动脉阻断时间（min）	72.70±24.23	84.78±18.34	t=2.893	0.004
辅助时间（min）	58.87±33.34	70.19±18.66	t=2.010	0.046
术中出血量（100 ml）	11.57±5.90	11.54±5.22	t=0.028	0.978
输注悬浮红细胞量（U）	5.37±3.13	4.62±2.38	t=1.685	0.097
输注血浆量（100 ml）	10.36±3.90	9.83±3.00	t=0.792	0.429
输注自体血量（100 ml）	10.94±6.83	9.47±6.70	t=1.219	0.224

术后资料	存活组（216例）	死亡组（37例）	统计值	P值
血清CRP［mg/L，M（Q₂₅，Q₇₅）］	79.35（68.8，101.67）	93.38（56.45，155.59）	Z=1.838	0.066
血清BNP［pg/ml，M（Q₂₅，Q₇₅）］	435（131.3，726）	206.7（109.27，504.54）	Z=1.719	0.086
总胆红素［μmol/L，M（Q₂₅，Q₇₅）］	49.99（39.76，72.06）	56.2（38.25，75.68）	Z=1.259	0.208
48 h累计引流量＞1 L［例（%）］	40（18.5）	14（37.8）	χ²=7.023	0.008
PaO₂/FiO₂＜300 mmHg［例（%）］	182（84.3）	35（94.6）	χ²=2.765	0.096
RRT-AKI［例（%）］	18（8.3）	24（64.9）	χ²=72.916	0.001
低心排［例（%）］	12（5.6）	18（48.6）	χ²=52.079	0.001

指标	B值	标准误差	瓦尔德	Exp（B）	95% CI	P值
年龄	0.160	0.041	15.381	1.174	1.083~1.272	0.001
术前伴器官灌注不良综合征	1.993	0.610	10.685	7.339	2.221~24.247	0.001
体外循环时间	0.031	0.008	14.210	1.031	1.015~1.048	0.001
术后48 h累计引流量＞1 L	0.582	0.681	0.729	1.789	0.471~6.796	0.393
术后RRT-AKI	2.525	0.652	14.978	12.490	3.477~44.866	0.001
术后低心排	2.662	0.844	9.948	14.325	2.740~74.897	0.002
常量	-16.830	3.315	25.777	-	-	-

References 23

1	中国医师协会心血管外科分会大血管外科专业委员会. 主动脉夹层诊断与治疗规范中国专家共识 [J]. 中华胸心血管外科杂志, 2017, 33(11): 641-654.
2	Merkle J, Sabashnikov A, Liebig L, et al. Factors predictive for early and late mortality after surgical repair for Stanford A acute aortic dissection [J]. Perfusion, 2019, 34(5): 375-383.
3	Tian L, Fan X, Zhu J, et al. Plasma D-dimer and in-hospital mortality in patients with Stanford type A acute aortic dissection [J]. Blood Coagul Fibrinolysis, 2014, 25(2): 161-166.
4	Crawford TC, Beaulieu RJ, Ehlert BA, et al. Malperfusion syndromes in aortic dissections [J]. Vasc Med, 2016, 21(3): 264-273.
5	Stevens PE, Levin A, Disease Kidney: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline [J]. Ann Intern Med, 2013, 158(11): 825-830.
6	Jiang W, Xu J, Shen B, et al. Validation of four prediction scores for cardiac surgery-associated acute kidney injury in Chinese patients [J]. Braz J Cardiovasc Surg, 2017, 32(6): 481-486.
7	张海涛, 杜雨, 曹芳芳, 等. 低心排血量综合征中国专家共识 [J]. 解放军医学杂志, 2017, 42(11): 933-944.
8	孙芳, 宋晓春, 陈永铭, 等. 急性Stanford A型主动脉夹层术后早期死亡因素分析 [J]. 中国心血管杂志, 2020, 25(2): 156-159.
9	林曦, 王晓武, 马涛, 等. 299例急性A型主动脉夹层术后死亡危险因素分析 [J]. 实用医学杂志, 2019, 35(8): 1255-1259.
10	Haldenwang PL, Wahlers T, Himmels A, et al. Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients [J]. Eur J Cardiothorac Surg, 2012, 42(5): e115-120.
11	Rao V, Ivanov J, Weisel RD, et al. Predictors of low cardiac output syndrome after coronary artery bypass [J]. J Thorac Cardiovasc Surg, 1996, 112(1): 38-51.
12	Chavanon O, Costache V, Bach V, et al. Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases [J]. Interact Cardiovasc Thorac Surg, 2007, 6(1): 43-46.
13	侯艳婷, 李虔桢, 吕晓钗, 等. 70岁以上急性A型主动脉夹层患者弓部重建的体外循环管理 [J]. 中华胸心血管外科杂志, 2019, 35(9): 537-540.
14	Narayan P, Rogers CA, Benedetto U, et al. Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection [J]. J Thorac Cardiovasc Surg, 2017, 154(1): 81-86.
15	Czerny M, Schoenhoff F, Etz C, et al. The impact of pre-operative malperfusion on outcome in acute type A aortic dissection: results from the GERAADA registry [J]. J Am Coll Cardiol, 2015, 65(24): 2628-2635.
16	崔聪, 张力, 高夏, 等. 急性A型主动脉夹层合并下肢缺血的治疗 [J]. 中华胸心血管外科杂志, 2018, 34(10): 593-596.
17	Li L, Zhou J, Hao X, et al. The incidence, risk factors and in-hospital mortality of acute kidney injury in patients after surgery for acute type a aortic dissection: a single-center retrospective analysis of 335 patients [J]. Front Med (Lausanne), 2020, 7: 557044.
18	Sasabuchi Y, Kimura N, Shiotsuka J, et al. Long-term survival in patients with acute kidney injury after acute type a aortic dissection repair [J]. Ann Thorac Surg, 2016, 102(6): 2003-2009.
19	Skripochnik E, Friedman P, Michler RE, et al. The outcome of surgical management of type A aortic dissection [J]. Asian Cardiovasc Thorac Ann, 2014, 22: 687-693.
20	Aljure OD, Fabbro M2nd. Cardiopulmonary bypass and inflammation: the hidden enemy [J]. J Cardiothorac Vasc Anesth, 2019, 33(2): 346-347.
21	Ge M, Wang Z, Chen T, et al. Risk factors for and outcomes of prolonged mechanical ventilation in patients received DeBakey type I aortic dissection repairment [J]. J Thorac Dis, 2021, 13(2): 735-742.
22	Hoefer D, Ruttmann E, Riha M, et al. Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A [J]. Ann Thorac Surg, 2002, 73(3): 714-718; discussion 718-719.
23	Lomivorotov VV, Efremov SM, Kirov MY, et al. Low-cardiac-output syndrome after cardiac surgery [J]. J Cardiothorac Vasc Anesth, 2017, 31(1): 291-308.

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