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著者: Igor Zindovic, Tomas Gudbjartsson, Anders Ahlsson, Simon Fuglsang, Jarmo Gunn, Emma C Hansson, Vibeke Hjortdal, Kati Järvelä, Anders Jeppsson, Ari Mennander, Christian Olsson, Emily Pan, Johan Sjögren, Anders Wickbom, Arnar Geirsson, Shahab Nozohoor
雑誌名: J Thorac Cardiovasc Surg. 2019 Apr;157(4):1324-1333.e6. doi: 10.1016/j.jtcvs.2018.10.134. Epub 2018 Nov 16.
Abstract/Text
OBJECTIVES: To evaluate the effect of preoperative malperfusion on 30-day and late mortality and postoperative complications using data from the Nordic Consortium for Acute Type A Aortic Dissection (ATAAD) registry.
METHODS: We studied 1159 patients who underwent ATAAD surgery between January 2005 and December 2014 at 8 Nordic centers. Multivariable logistic and Cox regression analyses were performed to identify independent predictors of 30-day and late mortality.
RESULTS: Preoperative malperfusion was identified in 381 of 1159 patients (33%) who underwent ATAAD surgery. Thirty-day mortality was 28.9% in patients with preoperative malperfusion and 12.1% in those without. Independent predictors of 30-day mortality included any malperfusion (odds ratio, 2.76; 95% confidence interval [CI], 1.94-3.93), cardiac malperfusion (odds ratio, 2.37; 95% CI, 1.34-4.17), renal malperfusion (odds ratio, 2.38; 95% CI, 1.23-4.61) and peripheral malperfusion (odds ratio, 1.95; 95% CI, 1.26-3.01). Any malperfusion (hazard ratio, 1.72; 95% CI, 1.21-2.43), cardiac malperfusion (hazard ratio, 1.89; 95% CI, 1.24-2.87) and gastrointestinal malperfusion (hazard ratio, 2.25; 95% CI, 1.18-4.26) were predictors of late mortality. Malperfusion was associated with significantly poorer survival at 1, 3, and 5 years (95.0% ± 0.9% vs 88.7% ± 1.9%, 90.1% ± 1.3% vs 84.0% ± 2.4%, and 85.4% ± 1.7% vs 80.8% ± 2.7%; log rank P = .009).
CONCLUSIONS: Malperfusion has a significant influence on early and late outcomes in ATAAD surgery. Management of preoperative malperfusion remains a major challenge in reducing mortality associated with surgical treatment of ATAAD.
Copyright © 2018 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
PMID 30578066 J Thorac Cardiovasc Surg. 2019 Apr;157(4):1324-1333.e6. doi: 10.1016/j.jtcvs.2018.10.134. Epub 2018 Nov 16.
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