Upper hemisternotomy versus full sternotomy access approach for Stanford A acute aortic dissection: a propensity score matching analysis / 中华胸心血管外科杂志

ABSTRACT

Objective:In comparison with full sternotomy, we explore the safety and clinical efficacy of upper hemisternotomy for Stanford A acute aortic dissection.Methods:Retrospective analysis of 78 patients with Stanford type A acute aortic dissection from January 2014 to December 2018(20 patients underwent UHS invasive, 58 patients underwent FS invasive). Based on variables including gender、age、BMI、LVEF、Euro SCORE Ⅱ and type of surgery, two matched cohorts including 18 patients respectively were constructed group UHS and group FS, the baseline data and perioperative indicators were analyzed.Results:Operative mortality was 3.9%(3 of 78). The patients＇baseline data were nearly balanced between the two groups after matching( P>0.05), only 1 case died of infectious cerebral hemorrhage in the FS group. The UHS group had a shorter cardiopulmonary bypass time than the FS group[(202±41)min vs.(235±39)min, P=0.041]. There was no significant difference in aorta clamping time[(159±38)min vs.(158±59)min, P=0.918] and hypothermic circulatory arrest time[(40±10)min vs.(50±20)min, P=0.081] between the two groups. The bladder temperature in the UHS group was significantly higher than that in the FS group[(24.0±3.1)℃ vs.(28.2±2.3)℃, P=0.001]. Compared with the FS group, the UHS group had less red blood cell transfusion[(4.8±2.8)U vs.(7.2±3.9)U, P=0.038], less postoperative drainage[(855±657)ml vs.(1510±703)ml, P=0.007], shorter ventilation support time(22 h vs. 58 h, P=0.037), shorter intensive care unit retention time[(4.6±2.7) days vs.(7.2±2.8) days, P=0.009], and shorter postoperative hospital stay time[(8.2±3.8) days vs.(18.4±3.8) days, P=0.001], but the incidence of pericardial puncture was higher in the UHS group[7(33%) vs. 1(6%), P=0.041]. 3 cases had postoperative renal insufficiency(requires dialysis), 5 cases(13.9%)had neurological complications, 1 case received re-exploration in the two groups respectively. Conclusion:The upper hemisternotomy approach is safe and feasible for Stanford A acute aortic dissection, with excellent early outcomes.