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首页> 外文期刊>Circulation journal >Brain protection during ascending aortic repair for stanford type A acute aortic dissection surgery - Nationwide analysis in Japan
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Brain protection during ascending aortic repair for stanford type A acute aortic dissection surgery - Nationwide analysis in Japan

机译：斯坦福型术中升级主动脉修复过程中的脑保护型急性主动脉夹层外科 - 全国在日本分析

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摘要

Background: The optimal brain protection strategy for use during acute type A aortic dissection surgery is controversial.Methods and Results: We reviewed the results for 2 different methods: antegrade cerebral perfusion (ACP) and retrograde cerebral perfusion (RCP), during ascending aortic repair for acute type A aortic dissection for the period between 2008 and 2012 nationwide. Cases involving root repair, arch vessel reconstruction and/or concomitant procedures were excluded. Using the Japan Adult Cardiovascular Surgery Database, a total of 4,128 patients (ACP, n=2,769; RCP, n=1,359; mean age, 69.1?1.8 years; male 41.9%) were identified. The overall operative mortality was 8.6%. Following propensity score matching, among 1,320 matched pairs, differences in baseline characteristics between the 2 patient groups diminished. Cardiac arrest time (ACP 116?6 vs. RCP102?8 min, P<0.001), perfusion time (192?4 vs. 174?3 min, P<0.001) and operative time (378?17 vs. 340?08 min, P<0.001) were significantly shorter in the RCP group. There were no significant differences between the 2 groups regarding the incidence of operative mortality or neurological complications, including stroke (ACP 11.2% vs. RCP 9.7%). Postoperative ventilation time was significantly longer in the ACP group (ACP 128.9?55.7 vs. RCP 98.5?01.7 h, P=0.018). There were no differences in other early postoperative complications, such as re-exploration, renal failure, and mediastinitis.Conclusions: Among patients undergoing dissection repair without arch vessel reconstruction, RCP had similar mortality and neurological outcome to ACP.
机译：背景：急性型急性型脑保护策略A主动脉夹层手术是有争议的。方法和结果：我们审查了2种不同方法的结果：促进脑灌注（ACP）和逆行脑灌注（RCP），在上升主动脉修复期间对于急性型为全国2008年至2012年期间的主动脉解剖。涉及根部修复，拱船重建和/或伴随程序的病例被排除在外。使用日本成人心血管手术数据库，共有4,128名患者（ACP，N = 2,769; RCP，N = 1,359;平均年龄，69.1〜1.8岁;鉴定了男性41.9％）。整体手术性死亡率为8.6％。在倾向得分匹配之后，在1,320对中，2患者组之间的基线特性的差异减少。心脏骤停时间（ACP 116？6 vs. rcp102？8分钟，p <0.001），灌注时间（192？4 vs.174？3分钟，p <0.001）和操作时间（378？17对340？08 min RCP组P <0.001）显着短。 2组关于手术死亡率或神经和神经并发症的发生率没有显着差异，包括中风（ACP 11.2％与RCP 9.7％）。 ACP组术后通风时间明显更长（ACP 128.9？55.7与RCP 98.5？01.7 H，P = 0.018）。其他早期术后并发症均无差异，例如重新探索，肾功能衰竭和纵隔型炎。结论：在没有拱血管重建的情况下进行解剖修复的患者中，RCP对ACP具有相似的死亡率和神经系统结果。

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  • 来源
    《Circulation journal》 |2014年第10期|共8页
  • 作者

    TokudaY.; MiyataH.; MotomuraN.; OshimaH.; UsuiA.; TakamotoS.;

  • 作者单位

    Department of Cardiac Surgery Nagoya University Graduate School of MedicineNagoya Japan;

    Japan Cardiovascular Surgery Database OrganizationTokyo Japan;

    Japan Cardiovascular Surgery Database OrganizationTokyo Japan;

    Department of Cardiac Surgery Nagoya University Graduate School of MedicineNagoya Japan;

    Department of Cardiac Surgery Nagoya University Graduate School of MedicineNagoya Japan;

    Japan Cardiovascular Surgery Database OrganizationTokyo Japan;

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  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 心脏、血管（循环系）疾病;
  • 关键词

    Aorta; Cardiopulmonary bypass; Dissection;

    机译：主动脉;心肺旁路;解剖;

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