Impact of the Duration of Global Cardiac Ischaemia on Outcomes of Acute Type A Aortic Dissection Repair.

Autor: Beliaev AM; Green Lane Cardiothoracic Surgical Unit, Auckland City Hospital, Auckland, New Zealand. Electronic address: andreibeliaev@hotmail.com., Bergin CJ; Anatomy with Medical Imaging FMHS University of Auckland, Auckland, New Zealand.
Jazyk: angličtina
Zdroj: Heart, lung & circulation [Heart Lung Circ] 2021 Jul; Vol. 30 (7), pp. 1067-1074. Date of Electronic Publication: 2021 Feb 13.
DOI: 10.1016/j.hlc.2020.12.014
Abstrakt: Background: The current management of acute type A aortic dissection (ATAD) repair does not consider the safe duration of cardiac ischaemia as an operative strategy. We aimed to evaluate whether the duration of cardiac ischaemia during ATAD repair can predict operative mortality and to determine the optimum cardiac ischaemia time that is associated with better outcomes.
Methods: This was a retrospective observational study. Patients who underwent ATAD repair from 2003 to 2020 were identified from our hospital records.
Results: Three hundred and sixty three (363) ATAD patients met eligibility criteria. The median patient age was 61 years, 221 (61%) patients were male. Duration of cardiac ischaemia was associated with operative mortality (Odds ratio [OR] =1.01; p<0.0005). Its optimal cut-off point was equal to or above 149.5 minutes (95% CI: 126.2-172.8). In patients with a shorter period (less than 150 mins) of cardiac ischaemia, a valve-sparing root repair was used more often (OR=2.5; 95% CI: 1.6-3.9; p<0.001). Procedures that had the longer period of cardiac ischaemia included the Bentall procedure (OR=10.9; 95% CI: 4.9-27.4; p<0.001), descending thoracic aorta replacement (OR=4.3; 95% CI: 1.007-18.7; p=0.049) and concomitant cardiac surgery (OR=4.7; 95% CI: 2-11.1; p<0.001). Operations associated with shorter cardiac ischaemia were associated with lower in-hospital mortality and better long-term survival.
Conclusion: This study determined that the duration of cardiac ischaemia in ATAD repair is linked to operative mortality. Further studies are required to confirm that ATAD patients with surgical repair involving less than 150 minutes of cardiac ischaemic time have lower in-hospital mortality and better long-term survival.
(Copyright © 2021 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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