Использывание антеградной перфузии головного мозга в хирургии дуги аорты в два раза снижает летальность и число неврологических осложнений: опыт лечения 1005 пациетнов

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Leontyev S. A., Davierwala P. M., Semenov M. , Mohr F. W.

Heart Center Leipzig;

Objective: Treatment of patients with extensive thoracic aortic disease (TAD) is associated with a higher operative morbidity and mortality as compared to other heart operations and involves the use of numerous surgical techniques. We retrospectively evaluated our 20-years experience in the treatment of TAD by analyzing the early and late outcomes of surgical repair of the thoracic aorta and identifying the clinical and surgical factors influencing them. Methods: Between July 1995 and February 2015, 1005 patients (mean age 62 ± 14 years) underwent elective and/or urgent aortic arch surgery. Chronic Type A and B aortic dissection were indications for surgery in 77 (7.7 %) patients, whereas degenerative or atherosclerotic aneurysms accounted for 822 (81.8 %) patients. Circulatory arrest (CA) was utilized in all patients. Antegrade selective cerebral perfusion (ASCP) was used in 701 (69.7%) patients. Results: The overall in-hospital mortality was 5.8 % (n=58) and was significantly lower in patients who received ASCP (4.4 %) compared to those who did not (8.9 %) (p=0.005). Permanent focal neurological deficit and paraplegia occurred in 5.6 % and 1.2 % of patients, respectively. Logistic regression analysis revealed age >70 years (OR 2.6, p=0.002), coronary artery disease (CAD) (OR 2.2, p=0.01), left ventricle ejection fraction (LVEF) <30% (OR 5.5, p=0.001), chronic aortic dissection (OR 3.0, p=0.007), and CA time >40 minutes (OR 3.3, p=0.02) as independent predictors of in-hospital mortality. Use of ASCP was protective for early survival (OR 0.3, p=0.001). One, five and ten-year survival was 87%, 78% and 62%, respectively. Cox regression analysis revealed that long-term mortality was independently predicted by age, LVEF <30%, CAD, PVD, previous stroke, prior cardiac surgery and total arch replacement, whereas good LVEF and bilateral ASCP were protective. Five and ten-year freedom from all aorta-related surgical and endovascular re-interventions was 89% and 84%, respectively. Conclusions: Elective aortic arch surgery is associated with acceptable early and late outcomes. The ASCP significantly improves early outcomes by reduction in in-hospital mortality and permanent neurological deficit.

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