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在以导管为基础的手术过程中Iatrogenic急性A型大动脉解剖的外科结果:一个STS心脏手术数据库分析
Tom X Liu1, S Christopher Malaisrie1, Melissa Medina1
1Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; Bluhm Cardiovascular Institute, Northwestern Medicine, Chicago, Illinois.
The Annals of thoracic surgery
|July 3, 2025
概括
在TAVR和PCI等手术后的Iatrogenic急性A型大动脉剖析 (iATAAD) 携带的手术死亡率明显高于自发剖析. 心脏性休克和机械支持使用预测iATAAD患者的结果不佳.
科学领域:
- 心血管外科心血管外科
- 干预心脏病学 干预心脏病学
- 大动脉疾病研究研究
背景情况:
- 在以导管为基础的手术后,Iatrogenic急性A型大动脉剖析 (iATAAD) 是一种罕见但严重的并发症.
- 对于经历iATAAD的患者的修复后结果存在有限的数据.
研究的目的:
- 为了比较iATAAD修复与自发性ATAAD (sATAAD) 的结果.
- 确定与iATAAD患者死亡相关的风险因素.
主要方法:
- 对胸部外科医生协会数据库的分析 (2017年7月-2023年12月).
- 971名iATAAD患者 (PCI,TAVR,TEVAR,其他导管) 与25026名sATAAD患者的比较.
- 排除了手术内剖析,先前的大动脉干预,创伤或感染的患者.
主要成果:
- iATAAD患者年龄较大,女性多,并具有较高的并发症和抗凝率.
- 在iATAAD (31.9%) 与sATAAD (18.2%) 中,手术死亡率明显高,TAVR和PCI亚型的死亡率最高.
- 在iATAAD中,为出血而重复手术的频率更高 (10.6%对比8.1%).
结论:
- 创伤性急性A型大动脉剖析与高手术死亡率有关,特别是在TAVR和PCI后.
- 心脏性休克和需要机械循环支持是iATAAD患者不良结果的关键预测因素.
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