Risk Factors For Early Death After Total Arch Replacement For Stanford A Aortic Dissection

Objective Acute Stanford type A aortic dissection(ATAAD)is one of the most critical and dangerous diseases in cardiovascular diseases.Despite improvements in diagnosis,medical treatment,and surgical techniques,the patient’s mortality rates are still high,with untreated patients having a mortality rate of up to 50% within a week,and a mortality rate of 60% to 70% within a month.At present,the first choice of treatment is timely surgical operation.Although the mortality rate has been greatly reduced with the continuous progress of surgery,the mortality rate after aortic dissection is still about10%.The purpose of this study is to collect the clinical data of ATAAD patients who underwent total arch replacement in hospital,and to statistically analyze the factors affecting the postoperative mortality of the patients,so as to provide reference suggestions for the diagnosis and treatment of clinical work and improving the prognosis in the future.Methods A retrospective analysis of 158 patients with Stanford type A aortic dissection who underwent total arch replacement at the Department of Cardiovascular Surgery,Provincial Hospital Affiliated to Anhui Medical University from December 2016 to May 2020.All patients were diagnosed by cardiac color Doppler ultrasound and CTA of the thoracic and abdominal aorta before operation and the preoperative laboratory examinations were perfected.According to whether death occurred 30 days after operation(including 30 days),they were divided into 14 cases in death group and 144 cases in survival group.And the clinical baseline data of the selected patients,including gender,age,body mass index(BMI),history of hypertension,diabetes,history of heart valve disease,left ventricular ejection fraction(LVEF),Pericardial effusion,preoperative liver function abnormality(alanine aminotransferase>40 U/L),preoperative renal function abnormality(creatinine>120 μmol/L),Marfan syndrome;operation time,cardiopulmonary bypass time(CPB),aortic block time,circulatory arrest time,intraoperative blood product volume;24 h postoperative drainage,whether postoperative blood transfusion,second thoracotomy,second intubation,liver injury(Alanine aminotransferase>200 U/L,and total bilirubin>50 mmol/L within 1 week after surgery),acute kidney injury(postoperative renal replacement therapy),ICU hospital stay and other aspects were retrospectively analyzed.Multivariate logistic analysis was performed on the factors with statistical significance in univariate analysis,and the risk factors affecting early postoperative death were analyzed and summarized.Results In this study,14 patients who underwent total arch replacement died 30 after the operation.There were 3 cases of bleeding due to postoperative dissection rupture,1case of mediastinal infection,2 cases of stroke,3 cases of renal failure,and 2 cases of acute heart failure.3 cases of poor perfusion of lower extremities.Compared with the survival group,the death group had abnormal renal function before operation(35.7% vs10.4%)and postoperative secondary intubation(50.0% vs 13.2%),liver injury(100% vs60.4%),and acute kidney injury(64.3% vs 15.3 %)were higher and the difference was statistically significant(P<0.05);in addition,the intraoperative aortic block time(164.223.3 min vs 144.725.5 min)in the death group was longer(P<0.05);multivariate logistic regression analysis showed: aortic block time(OR=1.056,95%CI: 1.005 ～1.109),secondary intubation(OR=4.974,95%CI: 1.079～22.925),acute kidney injury(OR =6.197,95%CI: 1.189～32.290)are independent risk factors for death in patients with ATAAD 30 days after surgery.Conclusion Aortic block time,postoperative secondary intubation,and acute kidney injury are risk factors for early death after total arch replacement in Stanford type A aortic dissection.Therefore,strengthening intraoperative and postoperative management and preventing postoperative complications are the key to reducing early postoperative mortality.