ABSTRACT
Objective@#To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns.@*Methods@#218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8±10.7) years and 170 were male(78.0%). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22.0%). Clinical data were compared between two groups and risk factors for short- and long-term mortality identified using Cox regression.@*Results@#Patients with renal malperfusion showed significantly higher incidences of short-term mortality(22.9% vs 8.3%, P=0.023), long-term mortality(87.0% vs 72.9%, P=0.003) and postoperative acute kidney failure(20.8% vs 4.1%, P<0.001). Renal malperfusion was the risk factor for short-term mortality(OR 2.92, 95%CI 1.31-6.63, P=0.009) and long-term mortality(OR 2.56, 95%CI 1.32-4.94, P=0.005).@*Conclusion@#Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.
ABSTRACT
Objective To find out what the exact impact of renal malperfusion on short- and long-term postoperative prognosis of ATAAD patietns. Methods 218 patients with ATAAD undergoing surgical repair from June 2009 to May 2012 . Mean age was(47.8 ±10.7) years and 170 were male(78.0％). Based on computed tomographic angiography and laboratory test, 48 patients were diagnosed with preoperative renal malperfusion(22. 0％). Clinical data were compared between two groups and risk factors for short-and long-term mortality identified using Cox regression. Results Patients with renal malperfu-sion showed significantly higher incidences of short-term mortality(22. 9％ vs 8. 3％, P =0. 023), long-term mortality (87. 0％ vs 72. 9％, P=0. 003) and postoperative acute kidney failure(20. 8％ vs 4. 1％, P<0. 001). Renal malperfusion wastheriskfactorforshort-termmortality(OR2.92,95％CI1.31-6.63,P=0.009) andlong-termmortality(OR2.56, 95％CI 1. 32-4. 94, P=0. 005). Conclusion Renal malperfusion significantly increases the postoperative risk of short-term mortality, long-term mortality and incidence of postoperative acute renal failure in patients with ATAAD.
ABSTRACT
Objective To confirm the impact of renal malperfusion on early and late outcomes of patients undergoing sur-gery for type A aortic dissection(TAAD). Methods From June 2011 to July 2012,a total of 165 TAAD patients undergoing surgery in hospital were enrolled and divided into 2 groups based on the results:research group(complicated with renal malper-fusion),control group(without renal malperfusion). A cohort follow-up project was conducted among these patients. The pri-mary outcome was all-cause death. Baseline and operative characteristics,early and late outcomes were analyzed to assess difference between 2 groups. Cumlative survival rates within 72 months among the 2 groups was described with Kaplan-Meier curves. Cox proportional hazards model was used to estimate the hazard ratios(HR)and 95％ confidence intervals(95％ CI)of late mortality among the 2 groups. Results Renal malperfusion was detected in 38(23. 0％)of 165 TAAD patients. 30-day mortality was 15. 8％ and 3. 9％ in patients with and without renal malperfusion(P < 0. 05),respectively. The mean follow-up period was(67 ± 3)months,late survival was 68. 4％ in patients with renal malperfusion and 88. 2％ in patients without(P <0. 05). By Cox proportional hazards model,after adjusting forage,sex,group(acute or chronic),presence of cardiac tampon-ade,brachiocephalic vessels involvement,coronary arteries involvement,root replacement,total arch replacement,concomitant coronary artery bypass grafting(CABG)and other organ-malperfusion,when compared to the control group,the HR(95％ CI) of late mortality was 5. 18( 1. 07 - 5. 18)in the research group. Besides renal malperfusion,concomitant coronary artery bypass grafting was presented as an independent risk factor of long-term survival(HR = 10. 08,95％ CI:2. 28 - 44. 62,P = 0. 002). Conclusion Coexistence of renal malperfusion is associated with a substantially increased risk of death in patients undergoing surgery for TAAD. A more exact stratification that weight every malperfusion-affected organ but not base on the number of malp-erfusion-affected organ simply may be more helpful to TAAD patients with malperfusion syndrome.