术后早期全身炎症反应综合征对急性Stanford A型主动脉夹层患者短期预后的影响

目的 探讨术后早期全身炎症反应综合征(SIRS)对急性Stanford A型主动脉夹层患者短期预后的影响.方法 回顾性分析2018年1月至2020年1月中国医学科学院阜外医院深圳医院ICU收治的急性Stanford A型主动脉夹层患者88例,其中男76例、女12例,年龄23～73(50.28±9.59)岁.根据术后24...     

急性A型主动脉夹层患者术前凝血因子活性R降低或增加术后神经系统并发症发生风险

目的 分析急性A型主动脉夹层患者急诊手术术后神经系统并发症的相关危险因素.方法 回顾性分析2018年10月至2019年5月我院收治的51例急性Stanford A型主动脉夹层患者资料,其中男37例(72.5％)、女14例(27.5％),年龄29～85(55.1±12.3)岁.将患者分为N1组(n=12,急诊手术后出现脑...     

A型主动脉夹层合并降主动脉真腔狭小的外科治疗策略

目的:探讨A型主动脉夹层合并降主动脉真腔狭小的外科治疗方法及疗效。方法:回顾性分析本中心2017年1月至2019年12月9例A型主动脉夹层合并降主动脉真腔狭小患者的临床治疗资料。其中男7例,女2例,年龄21～56(41.6±9.2)岁;急性夹层2例,慢性夹层7例,马方综合征5例。术前全主动脉CTA检查证实为A型主动脉夹...     

降钙素原对急性Stanford A型主动脉夹层患者术后感染的诊断价值

目的 探讨降钙素原(PCT)对急性Stanford A型主动脉夹层患者术后感染的诊断价值.方法 回顾性分析2017年6月至2019年12月中国医学科学院阜外医院深圳医院收治的急性Stanford A型主动脉夹层接受外科手术治疗的患者104例,男88例,女16例,年龄≥18岁.根据术后是否发生感染将患者分为两组:感染组(...     

新型弓部阻断孙氏手术治疗急性Stanford A型主动脉夹层—单中心67例早期临床结果分析北大核心CSCD

目的评估新型弓部阻断孙氏手术治疗急性Stanford A型夹主动脉夹层的安全性和有效性。方法回顾性分析安贞医院2019年12月至2022年12月期间67例急性Stanford A型主动脉夹层患者施行新型弓部阻断孙氏手术的临床资料, 分析其早期临床结果。结果本组患者体外循环时间(166.66±32.81)min, 主动脉阻断时间(100.49±19.96)min, 停循环时间(3.97±1.63)min, 最低鼻咽温度(25.716±1.304)℃, 最低膀胱温度(26.209±1.552)℃。全组患者住院死亡2例(2.98%), 脑梗塞3例(4.48%), 短暂性神经功能障碍4例(5.97%), 截瘫1例(1.49%), 需持续透析的肾衰竭4例(5.97%)。结论新型弓部阻断技术应用于急性Stanford A型主动脉夹层患者安全可靠, 是提高孙氏手术治疗急性Stanford A型主动脉夹层疗效的新策略。     

孙氏手术治疗急性Stanford A型主动脉夹层

目的 总结急性Stanford A型主动脉夹层采用孙氏手术(主动脉弓部替换加支架象鼻手术)的临床经验与随访结果.方法 2004年8月至2012年3月,73例急性A型夹层患者施行了孙氏手术,其中男60例、女13例,平均年龄49.6(26 ～79)岁.手术均采用深低温停循环、低流量选择性脑灌注技术.单纯行升主动脉替换加孙氏手术30例;主动脉根部替换(Bentall术)加孙氏手术10例,主动脉瓣及升主动脉替换加孙氏手术12例,主动脉瓣成形加孙氏手术21例(同时行主动脉窦重建16例),同期行冠状动脉旁路移植术( CABG)9例,术后通过CTA评价胸腹主动脉塑形及假腔愈合情况.结果 体外循环平均(248.1±69.8)min,选择性脑灌注(38.2±10.5)min.手术死亡5例(6.85％,5/73例).术后60例随访2个月～7.6年,术后3个月CTA复查显示,91.7％的患者主动脉夹层的假腔在膈肌水平形成血栓,患者术后1、5和7年的生存率分别是97％、87％和81％.结论 孙氏手术治疗急性A型主动脉夹层安全有效且远期效果令人满意.     

妊娠晚期及产褥期合并急性主动脉夹层的临床治疗策略

目的探讨妊娠晚期(孕晚期)及产褥期合并急性主动脉夹层的临床特点、治疗策略及治疗效果。方法回顾性分析2012年8月至2017年6月间上海长海医院7例妊娠合并急性主动脉夹层患者的临床资料。5例妊娠晚期、2例产褥期,Stanford A型主动脉夹层6例(85.7%)、B型1例(14.3%),年龄26~34(30.8±3.1)岁。患者发病时间为孕28周至产后18 d,其中5例孕妇发病时间平均(31.8±2.63)周。A型夹层患者心脏超声显示升主动脉最宽内径4.2~5.7(4.7±0.6)cm,2例合并主动脉窦瘤,3例为马方综合征(42.8%)。A型夹层患者主动脉处理方式为:Bentall手术1例,Bentall+Sun’s手术2例,升主动脉置换+Sun’s手术+冠状动脉旁路移植术1例,主动脉根部成形+升主动脉置换+Sun’s手术2例。B型夹层患者先行剖宫产后再行胸主动脉腔内修复术(thoracic endovascular aortic repair,TEVAR)。结果主动脉阻断时间51~129(85.5±22.9)min,体外循环时间75~196(159.0±44.0)min,中低温停循环+选择性脑灌注时间为20~30(23.8±3.5)min。所有母体及胎儿均存活,其中先行主动脉修复而后期行剖宫产的1例胎儿经诊断为脑瘫。孕妇及新生儿随访9个月至4年,随访期内除脑瘫胎儿外其余婴幼儿均发育生长良好;7例孕妇均恢复良好;早期先行主动脉修复的孕妇(仅1例),在后期剖宫产时发现乙状结肠破裂同期行乙状结肠造瘘术治疗;另1例A型夹层的产妇,出院2年后经诊断为胡桃夹综合征。结论妊娠晚期合并主动脉夹层多为A型夹层患者,马方综合征是妊娠合并急性主动脉夹层患者的高危因素。尽早手术并根据主动脉夹层类型及胎龄选择相应的治疗策略,妊娠晚期及产褥期合并主动脉夹层患者可获得良好的母儿结局。     

升主动脉和头臂干双动脉插管在急性A型主动脉夹层手术中应用的倾向性评分匹配分析

目的 探讨升主动脉、头臂干双动脉插管在急性A型主动脉夹层手术中的应用.方法 筛选2017年1月至2020年1月我院急性A型主动脉夹层患者183例,其中42例采用升主动脉、头臂干双动脉插管建立体外循环,为DAC组(男33例、女9例,中位年龄50岁);141例采用单独腋动脉插管建立体外循环,为AAC组(男116例、女25例...     

下肢缺血在急性主动脉夹层发病率的meta分析

近年来,国内外学者对急性主动脉夹层合并器官灌注不良越来越重视,但缺乏相关的流行病学数据。为明确下肢缺血在急性主动脉夹层的发病率,通过meta分析合成后,统计出下肢缺血在急性A型主动脉夹层(TAAD)和急性B型主动脉夹层(TBAD)的发病率分别为11%和10%;TAAD和TBAD合并下肢缺血的患者中男性分别占77.17%和84.35%。下肢缺血在急性主动脉夹层中占一定的比例,不论A型夹层还是B型夹层,男性患者发病率均高于女性。     

双马甲包裹法根部重建技术用于急性A型主动脉夹层的近端修复

目的:回顾性分析双马甲包裹根部加固重建方法近端修复急性A型主动脉夹层的近期疗效。方法:2018年1月到2019年10月,455例急性Stanford A型主动脉夹层患者接受了手术治疗。其中,双马甲包裹根部加固重建(DJW)343例(其中11例同时行瓣叶悬吊),Bentall手术81例,Wheat手术15例,未处理根部1...     

主动脉夹层手术后肝功能不全发生的相关危险因素分析

目的 分析Stanford A型和B型主动脉夹层患者在深低温停循环(DHCA)下主动脉替换手术后肝功能不全(HD)发生的相关危险因素.方法 收集2006年1月至2008年6月在DHCA(鼻温降至18 ℃)下行主动脉替换术的主动脉夹层病例208例,其中男性156例,女性52例,平均年龄(45±11)岁.术前诊断主动脉夹层Stanford A型181例,Stanford B型27例.记录患者的年龄、性别、术前合并症、术前心功能、主动脉夹层类型、手术类型、主动脉手术史、心肺转流时间、术中及术后24 h内的浓缩红细胞输入量.监测术前及术后1周内血谷丙转氨酶(GPT)、总胆红素及乳酸脱氢酶的水平.对术后HD发生的相关危险因素进行单因素分析及多因素Logistic回归分析.结果 该组病例术后早期(＜7 d)出现HD 18例(8.7%).术前血肌酐＞133 μmol/L(P＜0.01)、术前GPT＞40 U/L(P＜0.01)、急性夹层(P＜0.05)、心肺转流时间＞180 min(P＜0.05)、阻断时间＞100 min(P＜0.05)、术中及术后24 h内输注浓缩红细胞＞10单位(P＜0.01)是HD发生的相关危险因素.其中术前GPT＞40 U/L(P＜0.01)和术中及术后24 h内输注浓缩红细胞＞10单位(P＜0.01)是其独立危险因素.结论 主动脉夹层术后HD是多因素导致的并发症.术前GPT升高及术中、术后早期的大量输血是影响术后HD发生的主要原因.     

Preoperative risk factors for hospital mortality in acute type A aortic dissection

BACKGROUND: Acute type A dissection is associated with postoperative complications and a high mortality rate. This study was performed to determine the perioperative risk factors leading to hospital mortality in patients with acute type A aortic dissection. METHODS: One hundred twenty-two patients with acute type A aortic dissection treated surgically within 48 hours after onset were enrolled in this study. Thirty-two perioperative risk factors were used in statistical analysis for prediction of mortality. Risk factors for hospital death were investigated with univariate and multiple logistic regression analysis. RESULTS: The in-hospital mortality rate including operative death was 12.3% (15 of 122 patients) and the actuarial survival rate (including in-hospital death) was 72%+/-6% at 5 years. Univariate analysis revealed 10 risk factors to be statistically significant predictors of hospital death: age, year of operation (1990 to 1995), Marfan syndrome, preoperative ST segment elevation, heart failure from aortic regurgitation, preoperative shock, preoperative coma, long operation time (> 6 hours), long cardiopulmonary bypass time (> 4 hours), and massive blood transfusion (> 20 units) (p < 0.05). Multiple logistic regression analysis confirmed preoperative ST-T segment elevation and massive blood transfusion to be statistically significant independent risk factors for hospital death (p < 0.05). CONCLUSIONS: Preoperative ST-T elevation and massive blood transfusion during operation were identified as significant independent risk factors for hospital mortality after operation for acute type A aortic dissection. Our findings should contribute to estimation of operative risk in individual patients.     

The incidence and risk of acute renal failure after cardiac surgery

OBJECTIVE: To evaluate outcome and risk factors of acute renal failure in a surgical population with or without preoperative renal dysfunction. DESIGN: Observational study. SETTING: Intensive care unit at a University Hospital. PARTICIPANTS: Five thousand sixty-eight consecutive adult patients who underwent cardiac surgery with cardiopulmonary bypass. INTERVENTIONS: Perioperative variables measured were age, sex, basic pathology, preoperative renal impairment defined as creatinine >1.4 mg/dL, ventricular dysfunction, preoperative neurologic event, chronic obstructive pulmonary disease, diabetes, type of surgery, use of intra-aortic balloon pump (IABP), cardiopulmonary bypass (CPB) duration, redo or emergency surgery, hemorrhage, blood transfusion, surgical revisions, and postoperative complications. MEASUREMENTS and MAIN RESULTS: Acute renal failure (100% creatinine increase) developed in 171 (3.4%) patients, whereas 94 patients (1.9% of the population) had renal replacement therapy. Hospital mortality was 40.9% in patients with acute renal failure and increased to 63.8% when renal replacement therapy was requested. Sex, age, emergency surgery, low ejection fraction, IABP device, redo, diabetes, mitral valve surgery, CPB duration, and preoperative renal disease were independently associated with acute renal failure at a multivariate analysis. CONCLUSION: This study confirms that acute renal failure is one of the major complications of cardiac surgery, identifies the risk factors, and suggests that optimizing cardiac output and reducing CPB time could improve the outcome of patients at high risk of acute renal failure.     

Risk factors reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum assisted circuits

OBJECTIVES: Open heart surgery without homologous blood transfusion remains difficult in children. The introduction of vacuum-assisted cardiopulmonary bypass circuits to reduce priming volume for pediatric patients has improved the percentage of transfusion-free operations. We retrospectively analyzed blood transfusion risk factors to further reduce blood transfusion requirements after vacuum-assisted circuit introduction. METHODS: From March 1995 to June 1996, 49 patients weighing between 5 and 20 kg underwent cardiac surgery with cardiopulmonary bypass at our institution, excluding hospital deaths. We retrospectively analyzed risk factors influencing blood use in 37 patients with no blood priming in cardiopulmonary bypass after introducing a vacuum-assisted system. Factors selected for univariate analysis were age, body weight, cyanosis, preoperative Hb, operation time, cardiopulmonary bypass time, aortic cross-clamping time, and intraoperative and postoperative bleeding volume. Correlation between total bleeding volume/body weight and cardiopulmonary bypass time was studied by regression analysis. RESULTS: As risk factors, univariate analysis identified cyanotic disease, longer operation time (> 210 minutes), longer cardiopulmonary bypass time (> 90 minutes), longer aortic cross-clamping time (> 45 minutes), greater intraoperative bleeding volume/body weight (> 4 ml/kg), and greater postoperative bleeding volume/body weight (> 15 ml/kg). Regression analysis showed a significant positive correlation between total bleeding volume/body weight and cardiopulmonary bypass time. CONCLUSIONS: Cyanotic disease and long bypass time are risk factors in reducing blood transfusion requirements in pediatric open heart surgery after introduction of vacuum-assisted circuits. Further efforts are needed, however, to reduce blood transfusion requirements, particularly in these children.     

主动脉夹层手术后肝功能不全死亡的相关危险因素分析

目的 分析Stanford A型和B型主动脉夹层病人在深低温停循环(DHCA)下主动脉替换术后肝功能不全(HD)病人死亡的相关危险因素.方法 2006年1月至2008年6月在DHCA(鼻温降至18℃)下行主动脉替换术的主动脉夹层病人208例,术后出现HD 18例,其中男12例,女6例;年龄(43.2±11.2)岁.术前诊断主动脉夹层Stanford A型17例;Stanford B型1例.记录术后ICU停留时间、感染、脏器功能不全等并发症及结果.监测术后1周内血中谷丙转氨酶、总胆红素及乳酸脱氢酶水平,进行术后HD死亡的相关危险因素分析.结果 术后早期(＜7天)HD发生率为8.7%,其中7例病人死亡,占39%.HD死亡的相关危险因素包括:术后出血(P=0.049);急性肾功能衰竭(ARF)(P=0.049);多脏器功能不全(MOD)(P=0.004).其中术后出血(P=0.019)和MOD(P=0.001)是术后HD死亡的独立相关危险因素.结论 主动脉夹层术后肝功能不全的病人的病死率较高,术后出血及MOD导致术后肝功能不全病人死亡风险显著增加.

Abstract：

Objective There is a paucity of data regarding hepatic dysfunction (HD) following type A and B aortic dissection repair with deep hypothermic circulatory arrest (DHCA). We determine the incidence and outcomes for postoperative HD, and analyze the risk factors of death for HD. Methods Between January 2006 and June 2008, 208 patients have undergone open repairs of aortic dissection with DHCA. Indications for surgical intervention were type A aortic dissection in 181 patients and type B in 27 patients. 18 patients had postoperative hepatic dysfunction with abnormal hepatic enzyme and bilirubin.The mean patient age was 43 years and one third were women. Perioperative data including age, sex, type, surgery intervention, CPB time, aortic-clamp time and ICU retention time were collected. Complications were classified as bleeding, low cardiac output, acute renal failure, hypoxemia, infection, temporary neurologic dysfunction, multiple organ dysfunction and death.Serum GPT, LDH and TBIL were assayed and recorded before and after operation, as well as 12 h, 1 d, 3 d, 5 d, 7 d. Risk factors for death of hepatic dysfunction were ascertained by univariate and multivariable analysis. Results The incidence of hepatic dysfunction within one week following surgery is 8.7%. The mortality associated with HD was 39% compared with 1.6% (P＜0.0001) in patients without HD. ICU retention time were significantly different (P＜0.001) between HD grorp (11.9days) and non-HD group (4.2days). In this group, intraoperative and postoperative 24 hours blood transfusion volume (PRBC) ＞20 U occurred in 6 patients, reopen for bleeding in 3 patients, low cardiac output in 6 patients, sepsis in 1 patients, acute renal failure in 7 patients, hypoxemia in 5 patients, severe infection in 2 patients, temporary neurologic dysfunction in 5 patients, multiple organ dysfunction in 10 patients. Bleeding( P = 0. 024 ), low cardiac output (P = 0. 024 ), acute renal failure ( P = 0. 024), MOD ( P = 0.002) are the risk factors of death for hepatic dysfunction. And independent determinants were bleeding (P= 0.019) and MOD ( P = 0.001 ). Conclusion Multiple risk factors impact the onset of postoperative hepatic dysfunction. Bleeding and MOD after aortic dissection surgical repairs were associated with an increased mortality.     

Surgical repair of acute type A aortic dissection: continuous pulmonary perfusion during retrograde cerebral perfusion prevents lung injury in a pilot study

OBJECTIVE: Postoperative respiratory failure is a frequent and serious complication in patients with type A acute aortic dissection operated on with deep systemic hypothermia. Interaction between neutrophils and pulmonary endothelium along with ischemic insult and reperfusion are the major determinants of lung injury. The aim of this prospective study was to evaluate the effect of continuous pulmonary perfusion during retrograde cerebral perfusion on lung function. METHODS: Twenty-two patients referred for acute type A aortic dissection, who were free from preoperative respiratory dysfunction, were assigned prospectively and alternately to one of 2 treatment groups. Pulmonary perfusion was performed during retrograde cerebral perfusion in group B (11 patients), whereas the conventional Ueda technique was applied in group A (11 patients). Lung function was evaluated on the basis of intubation time, scoring of chest radiographs at 12 hours after cardiopulmonary bypass, and Pao(2)/fraction of inspired oxygen ratio assessed from immediately before the operation to 72 hours after termination of cardiopulmonary bypass. RESULTS: Study groups were homogeneous for age, sex, interval between symptom onset and surgical operation, previous aortic surgery, preoperative ejection fraction and pulmonary gas exchange function, extent of aortic repair, and concomitant procedures. Cardiopulmonary bypass time, length of retrograde cerebral perfusion, operation time, need for blood substitutes, and surgical revision for bleeding did not differ between treatment groups. Postoperative Pao(2)/fraction of inspired oxygen ratios were higher in group B than in group A, and the difference remained statistically significant throughout the study period. The incidence of prolonged ventilator support (>72 hours) and the severity of the radiographic pulmonary infiltrate score were lower in the perfused group (18.2% vs 72.7% [P =.015] and 0.81 +/- 0.75 vs 1.8 +/- 0.78 [P =.028], respectively). CONCLUSIONS: Continuous pulmonary perfusion provided a better preservation of lung function in patients operated on with deep systemic hypothermia.     

Predictors of transfusion requirements for cardiac surgical procedures at a blood conservation center

BACKGROUND: Previous studies defining perioperative risk factors for allogeneic transfusion requirements in cardiac surgery were limited to highly selected cardiac surgery populations or were associated with high transfusion rates. The purpose of this study was to determine perioperative risk factors and create a formula to predict transfusion requirements for major cardiac surgical procedures in a center that practices a multimodality approach to blood conservation. METHODS: We performed an observational study on 307 consecutive patients undergoing coronary artery bypass grafting, valve, and combined (coronary artery bypass grafting and valve) procedures. An equation was derived to estimate the risk of transfusion based on preoperative risk factors using multivariate analysis. In patients with a calculated probability of transfusion of at least 5%, intraoperative predictors of transfusion were identified by multivariate analysis. RESULTS: Thirty-five patients (11%) required intraoperative or postoperative allogeneic transfusions. Preoperative factors as independent predictors for transfusions included red blood cell mass, type of operation, urgency of operation, number of diseased vessels, serum creatinine of at least 1.3 mg/dL, and preoperative prothrombin time. Intraoperative factors included cardiopulmonary bypass time, three or fewer bypass grafts, lesser volume of acute normovolemic hemodilution removed, and total crystalloid infusion of at least 2,500 mL. The derived formula was applied to a validation cohort of 246 patients, and the observed transfusion rates conformed well to the predicted risks. CONCLUSIONS: A multimodality approach to blood conservation in cardiac surgery resulted in a low transfusion rate. Identifying patients' risks for transfusion should alter patient management perioperatively to decrease their transfusion rate and make more efficient use of blood resources.     

A preoperative index of mortality for patients undergoing surgery of type A aortic dissection.

BACKGROUND: The aim of this study was to identify and stratify the most important preoperative factors for in-hospital death after surgery for type A aortic dissection. METHODS: From January 1985 to June 1998, 108 patients underwent surgery for type A aortic dissection. 89.9% of the patients had an acute type A dissection (AD), whereas 11.1% had a chronic dissection (CD). Cardiac tamponade and shock occurred in 22% and 14.8% of the patients, respectively. The location of the primary intimal tear was in the ascending aorta in 71.2% of the cases, in the arch in 16.6% and in the descending aorta in 7.4%. Univariate and multivariate analyses were conducted to identify non-embolic variables independently correlated to in-hospital death. A predictive model of in-hospital mortality was then constructed by means of a mathematical method with the variables selected from logistic regression analysis. RESULTS: The overall in-hospital mortality rate was 20.3% (22/108 patients), being 9% for CD and 21.6% for AD. Emergent procedures had an in-hospital mortality rate of 47.6%, whereas non-emergent operations had an in-hospital mortality rate of 13.7% (p<0.01). Univariate analysis revealed among 39 preoperative and operative variables, age (years), age >70 years, remote myocardial infarction, cerebrovascular dysfunction, diabetes, preoperative renal failure, shock, cardiopulmonary bypass time (minutes), emergency operation as factors associated to in-hospital death (p<0.05). Stepwise logistic regression analysis selected as independent predicting variables (p<0.05), remote myocardial infarction (p=0.006), preoperative renal failure (p=0.032), shock (p=0.001), age >70 years (p=0.007). Finally, a probability table of death risk was obtained with the logistic regression coefficients. The lower death probability (10.6%) was calculated in absence of risk variables; the higher one in presence of all of them (79.7%). Between these extremes, a total of 64 combinations of death risk were obtained. CONCLUSIONS: Increasing age, shock, coronary artery disease and renal failure are variously associated to a high risk of in-hospital death after surgical correction of type A aortic dissection. This predictive model of death probability allows to collocate preoperatively patients with type A aortic dissection at different levels of risk for in-hospital death.     

Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience

BACKGROUND: Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era. METHODS: A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II). RESULTS: The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II ( P < .001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10). CONCLUSIONS: The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.     

Blood conservation in thoracic aortic surgery with total cardiopulmonary bypass

BACKGROUND: In thoracic aortic surgery, a large number of homologous transfusions sometimes cause systemic inflammatory response, which may lead to pulmonary dysfunction, renal dysfunction and brain edema. To predict the need for homologous blood transfusion in aortic surgery, we use blood transfusion index (preoperative Ht x body weight) to predict the magnitude of homologous transfusion. PATIENTS AND METHODS: From Dec 1997 to May 2000, 59 consecutive patients were underwent thoracic aortic graft replacement with total cardiopulmonary bypass. These patients were divided in 2 groups, who were underwent graft replacement without blood transfusions, and who needed blood transfusions. Each group was compared in age, sex, emergency, Ht, CPB time, blood transfusion index and operative mortality. RESULTS: Forty patients (67.7%) did not required blood transfusion. In elective cases (32 cases), 84.3% were underwent operation without blood transfusion. There was no significant difference between 2 groups in terms of age and mean bypass duration. Blood transfusion index was significantly higher in transfusion group (2,320 +/- 784) compared with that in not transfusion group (1,445 +/- 706). CONCLUSION: Blood transfusion index was useful preoperative parameter to predict the need for homologous transfusion.