Objective To assess the independent risk factors of in-hospital mortality and morbidity after surgical procedure for Stanford type A aortic dissection (TAAD). Methods Between May 2013 and May 2015, 341 TAAD patients were treated with surgical procedure in Fu Wai Hospital. There were 246 males and 95 females with a mean age of 47.42±11.54 years (range 29-73 years). Among them, 87 patients suffered severe complications or death after the procedure (complication group) and the other 254 patients recovered well without any severe complications (no complication group). Perioperative clinical data were compared between the two groups. Results Mean age of patients in the complication group was significantly higher than that of the no complication group (49.91±11.22 yearsvs. 46.57±11.54 years,P=0.019). The incidence of preoperative ischemic organ injury in the complication group was significantly higher than that in the no complication group: cerebral ischemia (18.4%vs. 5.9%,P=0.001), spinal cord injury (16.1%vs. 4.7%,P=0.001), acute kidney injury (31.0%vs. 10.6%,P=0.000). The incidence of branch vessels involvement in the complication group was significantly higher than that in the no complication group: coronary artery involvement (52.9%vs. 17.1%,P=0.000), supra-aortic vessels involvement (73.6%vs. 53.9%,P=0.001), celiac artery involvement (37.9%vs. 22.0%,P=0.003), mesenteric artery involvement (18.4%vs. 9.8%,P=0.030), and unilateral or bilateral renal artery involvement (27.6%vs. 9.8%,P=0.000). Surgical time of patients in the complication group was significantly longer than that of the no complication group, including cardiopulmonary bypass time (205.05±63.65 minvs. 167.67±50.24 min,P<0.05) and cross-clamp time (108.11±34.79 minvs. 90.75±27.33 min,P<0.05). Multiple regression analysis found that age, preoperative concomitant cerebral ischemic injury, preoperative concomitant acute renal injury, preoperative limb sensory and/or motor dysfunction, coronary artery involvement, cardiopulmonary bypass time were independent risk factors of postoperative death and severe complications in TAAD patients. However, risk of postoperative mortality and morbidity significantly decreased after the concomitant coronary artery bypass graft [OR=0.167 (0.060, 0.467),P=0.001]. Conclusion The high risk factors of postoperative complication in TAAD patients are explored to provide an important clinical basis for preoperative identification of patients at high risk and we need pay more attention to the prevention of these postoperative complications.
ObjectiveTo investigate the feasibility and effectiveness of using ultrasound to evaluate the internal mammary artery (IMA) and explore the related factors affecting the quality of IMA.MethodsFrom July 2020 to January 2021, for patients who underwent coronary artery bypass grafting at the Department of Cardiovascular Surgery, Fuwai Hospital, ultrasound was applied to measure bilateral IMA at the parasternal second intercostal space. There were 62 males and 18 females with an average age of 59.9±8.3 years. The clinical data of the patients were recorded and analyzed.ResultsA total of 160 IMA were measured. The IMA was detected in 99.4% (159/160), and the one that was not measured was proved to be occluded by enhanced CT. A total of 157 (98.1%) IMA intima were smooth, 2 (1.3%) were found to have uneven intimal thickening and less smooth, and only 1 (0.6%) was occluded. The intravascular diameter, peak systolic flow rate, peak diastolic flow rate, and blood flow rate of the left second intercostal IMA were 1.9±0.3 mm, 66.8±17.7 cm/s, 6.4 (0.0, 9.7) cm/s, 19.7±9.4 mL/min; and those of the right one were 2.1±0.3 mm, 69.7±18.5 cm/s, 6.0 (0.0, 9.2) cm/s and 22.8±11.5 mL/min, respectively. IMA vessel diameter and blood flow were greater on the right than those on the left side in the same individual (P<0.01). In univariate analysis, sex and body surface area were the factors that influenced the size of the IMA vessel among different individuals, and by linear regression analysis, the size of the IMA vessel was only related to body surface area among different individuals. On univariate analysis, diabetes mellitus was the only factor affecting IMA blood flow, with a mean reduction in blood flow of 18.4% (left) and 21.7% (right) in the diabetic group (P<0.05).ConclusionPreoperative evaluation of the IMA using ultrasound over the parasternal second intercostal space is easy, noninvasive, and has a high success rate. The internal diameter of the IMA is positively correlated with body surface area, and blood flow is significantly reduced in patients with diabetes.