Optimized selective arterial perfusion approach in total aortic arch replacement of stanford type a aortic dissection / 第二军医大学学报

ABSTRACT

Objective To explore the curative effect of optimized selective arterial perfusion approach in the total aortic arch replacement of the Stanford type A aortic dissection. Methods From Sep. 2016 to Oct. 2017, 31 Stanford A aortic dissection patients received total aortic arch replacement with cardiopulmonary bypass of optimized selective arterial perfusion approach (O-CPB group, 25 males and 6 females, aged [50.87±9.08] years old) in our hospital. And 60 Stanford A aortic dissection patients, who underwent total aortic arch replacement with cardiopulmonary bypass of traditional approach in our hospital from Jan. 2015 to Oct. 2017, were included as control (T-CPB group, 52 males and 8 females, aged [48.38±12.46] years old). The perioperative blood biochemistry parameters and clinical data were compared between the two groups. Multivariate logistic regression was used to analyze the risk factors for postoperative 30-day mortality. Results Compared with the T-CPB group, the O-CPB group had significantly shorter extracorporeal circulation time, circulatory arrest time and operation time ([206.90±39.92] min vs [276.37±29.92] min, [5.03±1.54] min vs [21.73±6.67] min and [396.68±58.57] min vs [469.28±69.77] min, all P0.01). The blood consumption volume and ICU detention time were significantly less in the O-CPB group versus the T-CPB group ([1 401±738] mL vs [1 705±580] mL and [5.94±2.45] d vs [7.42±3.53] d, both P0.05). The postoperative blood lactate and C-reactive protein concentrations in the O-CPB group were significantly lower than those in the T-CPB group ([6.10±3.80] mmol/L vs [8.11±4.51] mmol/L and [72.13±22.86] mg/L vs [84.78±17.07] mg/L; P0.05, P0.01). The patients in the O-CPB group were awake earlier than those in the T-CPB group ([3.32±1.11] h vs [4.14±1.59] h, P0.05). The absolute value of postoperative Richmond agitation-sedation scale (RASS) score of the O-CPB and T-CPB groups were 1.23±1.06 and 2.15±1.30, respectively, and the difference was statistically significant (P0.01). In O-CPB group, the oxygenation index was significantly higher and mechanical ventilation time was significantly shorter versus the T-CPB group ([234.42±79.51] mmHg vs [183.10±77.26] mmHg and [50.19±37.63] h vs [70.12±40.84] h; P0.01, P0.05; 1 mmHg＝0.133 kPa). There was no significant difference in the postoperative 30-day mortality rate between the O-CPB and T-CPB groups (6.45% [2/31] vs 11.67% [7/60], P0.05). Multivariate logistic regression showed that circulatory arrest time≥31 min and blood consumption volume≥1 390 mL were independent risk factors of postoperative 30-day mortality of Stanford A aortic dissection patients undergoing total aortic arch replacement, with OR (95% CI) being 1.517 (1.153-1.995) and 1.006 (1.002-1.010), respectively. Conclusion With bilateral antegrade selective cerebral perfusion and moderate hypothermia perfusion in lower body, the optimized selective arterial perfusion approach needs shorter circulatory arrest time, and less blood consumption compared with cardiopulmonary bypass of traditional approach. Moreover, it has a good protective effect on the brain and lung during total aortic arch replacement of Stanford type A aortic dissection.