ObjectiveThe Stanford classification does not differentiate between antegrade and retrograde primary entry tears in acute Stanford type A aortic dissection (ATAAD). The 2020 Society for Vascular Surgery/Society of Thoracic Surgeons (SVS/STS) classification categorizes ATAAD into SVS/STS-A and SVS/STS-B0 based on the location of the primary entry tear; however, its clinical utility requires further validation. This study aims to evaluate the impact of the SVS/STS-A and SVS/STS-B0 on the prognosis and strategies for ATAAD.MethodsWe retrospectively reviewed 931 consecutive ATAAD patients at Union Hospital (Wuhan, China) from June 2012 to August 2025. According to the SVS/STS classification criteria, patients were classified as the SVS/STS-A (n = 743) and SVS/STS-B0 (n = 188) dissection. Baseline demographics, aortic anatomical features, treatment strategies, and clinical outcomes were compared between the two groups.ResultsThe SVS/STS-A patients had more severe proximal aortic pathology, while the SVS/STS-B0 patients had more extensive distal involvement. The SVS/STS-A group underwent more aortic root replacement (36.8% vs. 7.7%, P < 0.001), aortic valve replacement (35.7% vs. 9.9%, P < 0.001), and coronary artery bypass grafting (35.1% vs. 9.2%, P < 0.001). In contrast, the SVS/STS-B0 group underwent more total arch replacement (78.2% vs. 65.1%, P = 0.012) and the stented elephant trunk procedure (78.9% vs. 59.1%, P < 0.001). In the overall cohort, the SVS/STS-A group demonstrated higher 24 h mortality (9.8% vs. 1.1%, P < 0.001), in-hospital mortality (24.2% vs. 14.4%, P = 0.004), and 3-year all-cause mortality (31.70% vs. 17.80%, P = 0.0005) compared to the SVS/STS-B0 group. In the open surgery subgroup, no significant prognostic difference existed between the two types. In the non-surgery subgroup, the SVS/STS-A group had significantly higher 24 h mortality (31.6% vs. 5.7%, P = 0.002) and in-hospital mortality (49.5% vs. 8.6%, P < 0.001).ConclusionsThe SVS/STS classification provides effective preoperative risk stratification for ATAAD. The SVS/STS-A dissections carry a higher early mortality risk, necessitating urgent surgical intervention with aggressive management of the aortic root. In contrast, the SVS/STS-B0 dissections allow a wider surgical window, with strategies emphasizing arch replacement and distal remodeling.

The objective of this study was to compare clinical outcomes of total arch replacement (TAR) combined with stented elephant trunk (SET) implantation and hybrid aortic arch repair (HAAR) for type A acute aortic dissection (TA-AAD) in patients older than 60 years.We studied records of patients with TA-AAD older than 60 years in our hospital between January 2016 and December 2018. About 68 patients underwent TAR combined with SET implantation (SET group), and 56 patients underwent HAAR (hybrid group). Outcomes included operative data, postoperative data, and 2 years of follow-up data.Comparing with the SET group, the hybrid group experienced shorter time on surgery duration (p < 0.001), cardiopulmonary bypass (p < 0.001), aortic cross-clamp (p < 0.001), mechanical ventilation (p < 0.001), ICU stay (p < 0.001), and hospital length of stay (p < 0.001). The hybrid group showed a lower rate of pulmonary infection and renal failure (p = 0.023; p = 0.022, respectively). Blood product use was less in the hybrid group (p < 0.001). The hybrid group had a trend toward reducing the 30-day mortality rate, stroke, and transient mental dysfunction. The hybrid group had a trend toward improving the 2-year survival rate and reintervention-free rate, but the results did not reach a significant level.Hybrid procedure could be safely performed in patients older than 60 years with TA-AAD. This procedure may be associated with encouraging surgical results and promising outcomes in the early and mid-term.

Purpose Myocardial ischemia/reperfusion (I/R) injury is a potential complication associated with ischemic heart disease after recanalization. Diosmetin (Dios) is a natural flavonoid found in citrus species with therapeutic effects on several cardiovascular conditions. This study aims to explore the protective effects and mechanisms of Dios on myocardial I/R injury. Methods H9c2 cells were incubated with hydrogen peroxide (H2O2) in vitro to establish a cell model. An in vivo murine model of myocardial I/R injury was also established. The H9c2 cells or mice were exposed to Dios in the presence or absence of silent information regulator 1 (SIRT1) small interfering RNA (siRNA) or the selective SIRT1 inhibitor EX527. Immunoblotting, DHE staining, immunofluorescence, comet assay, Evans blue/TTC staining, terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL) assay, enzyme-linked immunosorbent (ELISA) assay, and cell counting kit-8 (CCK-8) assay were performed. Results Dios treatment reduced H2O2-induced reactive oxygen species (ROS) deposition, inflammation, DNA damage and apoptosis in H9c2 cells. Mechanistically, Dios activated the SIRT1/nuclear factor erythroid 2-related factor 2 (NRF2) pathway, whereas SIRT1 siRNA abolished Dios-mediated SIRT1/NRF2 activation and cardioprotective effects. Consistent results were observed in vivo, where Dios treatment conferred protection against myocardial injury induced by I/R, as evidenced by the decreased myocardial infarction size, ROS deposition, reduced TUNEL-positive ratio, and improved cardiac function. The protective effects were abolished by EX527. Conclusion Our findings demonstrate that Dios ameliorates myocardial I/R injury by reducing oxidative stress, inflammation, DNA damage, and apoptosis via activating the SIRT1/NRF2 pathway.

IntroductionReintubation is an adverse postoperative complication in patients with Type A aortic dissection (AAD) that correlates to poor outcomes. This study aims to employ machine learning algorithms to establish a practical platform for the prediction of reintubation.MethodsA total of 861 patients diagnosed with AAD and undergoing surgical procedures, 688 patients as training and testing cohort from a single center, and 173 patients as validation cohort from four centers were enrolled. The least absolute shrinkage and selection operator (LASSO) was used for screening risk variables associated with reintubation for subsequent model construction. Subsequently, seven machine-learning models were built. The model with the best discrimination and calibration performance was used to predict reintubation. Finally, the SHapley Additive exPlanation (SHAP) was employed to explain the prediction model.ResultsReintubation was performed in 107 patients (12.43%). The LASSO analysis identified re-admission to the intensive care unit (ICU), continuous renal replacement therapy, length of stay in the ICU, and duration of invasive mechanical ventilation as significant risk factors for reintubation. The XGBoost model was selected as the final prediction model due to its better performance than other models, with the AUC, sensitivity, and specificity of 0.969, 0.8889, and 0.8611 in the testing cohort. SHAP values demonstrated the effects of individual features on the overall model. Finally, a web calculator was developed based on XGBoost model for the clinical use.ConclusionWe have developed and validated a high-performing risk prediction model for postoperative reintubation in patients with AAD. It can provide valuable guidance to clinicians in predicting reintubation and in developing timely preventative measures.

Introduction Axillary artery cannulation (AAC) has been widely employed in total arch replacement surgeries using the frozen elephant trunk (FET) technique for acute type A aortic dissection (ATAAD), showing better clinical results than femoral artery cannulation (FAC). Nevertheless, in type II hybrid arch repair (HAR), FAC is crucial for lower body perfusion. Hence, it is unclear whether AAC remains necessary or if AAC represents a more advantageous method for initiating cardiopulmonary bypass. Methods We conducted a study involving patients diagnosed with ATAAD who underwent type II HAR from August 2021 to December 2022. Demographic baseline and intraoperative data were collected, and the postoperative outcomes of patients receiving FAC only were compared with those receiving AAC. Results There were no significant differences in baseline demographics between patients who underwent FAC alone ( n = 46) and those who underwent AAC ( n = 39). Patients who underwent AAC showed a lower incidence of transient neurological dysfunction (TND) post-surgery compared to those who underwent FAC (12.8% vs 32.6%, p = .032). There were no significant differences between the groups in terms of postoperative mortality within 30 days, permanent neurological dysfunction (PND), length of stay in the intensive care unit (ICU) and postoperative ward, duration of mechanical ventilation, and other complications. Conclusions Axillary artery cannulation may decrease the incidence of postoperative transient neurological dysfunction (TND) in type II HAR for ATAAD. Nonetheless, studies with larger sample sizes are necessary.

Introduction Cardiac blood cyst is a very rare benign tumor of the heart in adults. Though it is very common in the first half year of life, it regresses with time and its occurrence is very rare in children older than six months and in adults. Until now less than 100 valvular blood cyst cases have been reported in adults. Case presentation We present a case of a 66-year-old male who presented to us with exertional chest tightness, shortness of breath, and right leg weakness for two weeks. He was diagnosed with a cardiac mass two months ago in another hospital. The physical examination was unremarkable. Abdominal ultrasound showed a cyst in the liver and left kidney. Echocardiography showed a mass-occupying lesion of a cystic nature in the mitral valve with moderate mitral regurgitation. Based on echocardiography findings and computed tomography report, the preliminary diagnosis of mitral valve cystic tumor was made. The patient underwent minimally invasive resection of the cyst. The posterior mitral cusp was repaired and a mitral annuloplasty ring was placed. The postoperative recovery was uneventful. The histopathology report confirmed the diagnosis of a cardiac blood cyst. The patient was followed up for six months without any complications. This case is presented to enrich the medical literature on the cardiac blood cyst. Conclusion Although a cardiac blood cyst is a rare entity in adults, it still should be considered in the differential diagnosis of cardiac tumors. Because the natural history and hemodynamic effects are very diverse, large symptomatic cardiac blood cysts, especially in the left heart should be resected to avoid complications.

Objective:To evaluate the predictive value of age-adjusted Charlson comorbidity index (ACCI) for in-hospital mortality and 1-year mortality in patients with acute type A aortic dissection (ATAAD).Methods:This was a retrospective cohort study, and the clinical data of ATAAD patients admitted to Wuhan Union Hospital from January 1, 1999 to December 31, 2018 were collected for analysis. All the patients were confirmed by computed tomography angiography or magnetic resonance imaging of the aorta and the onset time was less than 14 days. Patients who survived at discharge were followed up to obtain 1-year survival information. The ACCI score was calculated for patients based on their comorbidities and age at admission, and they were divided into three groups of 0, 1 and ≥2 according to the ACCI score. The in-hospital mortality and 1-year mortality of the three groups were compared. Logistic regression analysis was applied to determine the independent predictors for in-hospital mortality and 1-year mortality.Results:Among 1 133 ATAAD patients, 383, 357 and 393 patients had ACCI score of 0, 1, and ≥2, respectively. The in-hospital mortality and 1-year mortality of patients with ACCI score ≥2 were significantly higher than those of patients with ACCI score of 0 (25.4% vs. 17.0%, 30.0% vs. 19.6%, both P<0.05). Multivariate Logistic regression analysis showed that ACCI score ≥2 was an independent risk factor for in-hospital mortality ( OR=1.670, 95% CI: 1.176-2.370, P=0.004) and 1-year mortality ( OR=1.762, 95% CI: 1.264-2.456, P<0.001). Age (per 10-year increase) and cerebrovascular diseases were independent risk factors for in-hospital mortality and 1-year mortality, while diabetes mellitus was a protective factor for in-hospital mortality. Conclusions:ACCI can predict the in-hospital mortality and 1-year mortality of ATAAD patients, and patients with ACCI score ≥2 have a poorer prognosis.

Behcet's disease (BD) is a multisystem inflammatory disease that is characterized by oral aphthosis, genital aphthosis, ocular lesions, and cutaneous lesions. Although BD rarely affects the cardiovascular system, its symptoms can be shown as aortic regurgitation (AR), which requires surgical intervention. Due to the special pathogenesis of BD, a low preoperative diagnosis rate and a high incidence of serious complications, such as perivalvular leakage, valve detachment, and pseudoaneurysm after prosthetic valve replacement, surgical treatment of BD with severe AR has a poor prognosis. In recent years, new surgical strategies have been developed to improve treatment efficacy for this disease. This article reviews and summarizes the evolution of surgical techniques for BD with AR and aims to provide a reference for optimizing surgical strategies, improving perioperative management, and assisting prognosis in patients suffering from BD with severe AR.

Left ventricular assist device in combination with clenbuterol has been demonstrated to significantly improve heart function in patients with advanced heart failure. However, the roles of clenbuterol in mechanical unloading and its underlying mechanism are poorly understood. A rat abdominal heart transplantation model has been developed to mimic mechanical unloading of the heart. The recipient rats were randomly segregated into experimental groups for the daily administration of either saline (the "Trans" group; n = 13) or clenbuterol (2 mg/kg, the "Trans + CB" group; n = 12). Another group of 10 rats served as a treatment mimic control/sham animals (the "Sham" group). All interventions were performed via intraperitoneal injections once daily for 4 weeks. The Trans group animals exhibited myocardial atrophy and dysfunction with decreased expression levels of transient receptor potential channel 3 (TRPC3) and phospholipase C-β1 (PLC-β1) at 4 weeks post-transplantation. Administration of clenbuterol improved cardiac function, prevented myocardial atrophy, and restored expression of TRPC3 and PLC-β1 in the unloaded hearts of the "Trans + CB" animals at 4 weeks post-transplantation. Silencing of the TRPC3 gene by siRNA inhibited the pro-hypertrophic effect of clenbuterol in the rat primary cardiomyocytes in vitro. Furthermore, U73122, an inhibitor of the PLC-β1/diacylglycerol (DAG) pathway, significantly attenuated clenbuterol-induced upregulation of TRPC3 in cardiomyocytes. These findings suggest that the anti-atrophic effect of clenbuterol may be dependent on the upregulation of TRPC3 through the activation of the PLC-β1/DAG pathway during mechanical unloading. The results of our study reveal a potential target for the prevention and treatment of mechanical unloading-induced myocardial atrophy.

Ventricular septal rupture (VSR) after acute myocardial infarction (AMI) is a rare but often fatal complication. Surgery is considered the preferred treatment, although the optimal timing is discussed. The immediate preoperative hemodynamic status significantly impacts postoperative outcomes, making mechanical circulatory support (MCS) devices crucial for perioperative hemodynamic stability. We present the case of a 61-year-old woman with no remarkable cardiological history admitted to our hospital with a diagnosis of AMI and VSR. Due to hemodynamic instability and cardiogenic shock, we utilized an intra-aortic balloon pump (IABP) and an extracorporeal left ventricular assist device (extra-VAD) as a bridge to surgery. After 17 days of IABP support, the patient experienced hemodynamic instability, elevated lactate levels, pulmonary edema, and eventually bedside endotracheal infiltration inventor-assisted breathing. Subsequently, the IABP was removed, and the patient underwent 6 days of extra-VAD therapy, resulting in hemodynamic stability, a decline in lactate levels, and a reduction in pulmonary edema on X-ray. Surgical coronary artery bypass grafting and VSR repair were successfully performed without periprocedural complications, and the patient was subsequently discharged. Extra-VAD is useful for serious cardiogenic shock in patients with VSR after AMI and may be considered a reasonable approach as a bridge to surgery.

BackgroundThis study aimed to investigate the impact of branch vessel involvement on organ malperfusion and mid-term survival in patients with acute type A aortic dissection (ATAAD).MethodsBetween January 2019 and December 2020, 493 consecutive patients with angiographically confirmed ATAAD were retrospectively analysed. Preoperative computed tomography angiography parameters (branch artery involvement, longitudinal extent of dissection) were reviewed. The incidence of organ malperfusion, in-hospital mortality, and mid-term outcomes of patients with and without branch vessel involvement were compared.ResultsBranch vessel involvement was detected in 407 patients (82.6%), and organ malperfusion was observed in 234 patients (47.5%). The incidence of organ malperfusion was significantly higher in patients with branch vessel involvement compared with patients without it (52.6% vs. 23.3%, p < 0.001). Patients with coronary artery involvement (32.5%) were more likely to manifest as clinical malperfusion, whereas it occurred only 19.4% in patients with renal artery involvement. In-hospital mortality was higher in patients with branch vessel involvement (19.9% vs. 8.1%, p = 0.010). Median follow-up time was 16.1 months. Two-year survival rate was lower in patients with branch vessel involvement (76.3% vs. 84.5%, p = 0.085) or organ malperfusion (68.3% vs. 86.0%, p < 0.001). Multivariable analysis identified cardiac, cerebral, visceral and renal malperfusion as independent predictors for in-hospital mortality.ConclusionsOnly a small proportion of branch vessel involvement was associated with corresponding organ malperfusion in patients with ATAAD. Branch vessel involvement had a greater effect on short-term outcomes than mid-term survival, and organ malperfusion was related to a worse prognosis beyond it.

Marine biofilms are multispecies microbial communities on surfaces that are crucial to the marine environment. They cause marine corrosion, biofouling, and transmission of marine pathogens and thus pose a great threat to public health and the maritime industry. To control marine biofilms, effective and environmentally friendly antibiofilm compounds are highly needed. Elasnin is a potent antibiofilm compound that exhibits high efficiency in inhibiting marine biofilms and biofouling, but its mode of action remains unclear. In the present study, multiomic analysis combined with quorum-sensing assays and in silico study revealed that elasnin acted as a signaling molecule in the microbial community. Elasnin promoted the growth of dominant species in the biofilm but deprived their ability of sensing and responding to environmental changes by disturbing their regulations of the two-component system, i.e., the ATP-binding cassette transport system and the bacterial secretion system. Consequently, biofilm maturation and subsequent biofouler settlement were inhibited. Elasnin also exhibited higher antibiofilm efficiency than dichlorooctylisothiazolinone and had low toxicity potential on the embryos and adults of marine medaka fish. Overall, this study provided molecular and ecological insights into elasnin's mode of action, highlighting its application potential in controlling marine biofilms and the feasibility and advantages of using signal molecules to develop eco-friendly technologies.

BackgroundType A aortic dissection (TAAD) is a cardiovascular emergency condition with high mortality rate. Hybrid total aortic arch replacement using endovascular graft for the descending aorta repair results in favorable outcomes and has been recommended as an alternative procedure for the higher-risk category patients. Our institution started applying the upper ministernotomy incision technique for the hybrid procedures back in 2018.MethodsWe collected patients who underwent hybrid total arch replacement (HTAR) via ministernotomy (96) and total arch replacement with frozen elephant trunk (TAR + FET) procedures (99), between 2018 and 2021. The baseline information, intraoperative and postoperative characteristics have been compared. Kaplan-Meier analysis was used for survival evaluation. Cox regression were applied to identify the independent predictor of mortality.ResultsThe baseline characteristics between the two patient groups were compared and found similar, except that RBC counts were higher (p = 0.038) and the ascending aorta diameter was smaller (P = 0.019) in the “HTAR” group relative to the “TAR + FET” group. The cardiopulmonary bypass time (P < 0.001), the aortic cross clamp time (P < 0.001), the operation duration (P = .029), ICU (P = 0.037) and postoperative hospital stay (P = 0.002) were shorter in the “HTAR” group. The “HTAR” group exhibited also significantly lower levels of intraoperative transfusion (all <0.001) characteristics than the “TAR + FET” group. The hospital mortality and 1-year mortality revealed similar patterns in both groups.ConclusionHTAR via ministernotomy have similar short term prognosis, and also reduced the ICU and postoperative hospital stay. In all, The application of the ministernotomy technique in HTAR was safe and technically feasible and may benefit individual patients as well as hospitals in general.

Abstract Background: This case report describes a rare complication encountered in a 37-year-old male patient with subacute Type A aortic dissection. Case presentations: The patient underwent a Bentall procedure, total arch replacement, descending thoracic aorta elephant trunk stent implantation, mitral valve repair, and tricuspid valve repair. Postoperatively, the patient exhibited poor blood flow in the lower extremities and kidneys. Digital Subtraction Angiography (DSA) revealed an angulation and stenosis at the proximal end of the elephant trunk stent, leading to inadequate blood supply. Balloon angioplasty and stent graft implantation were performed using a Thoracic Endovascular Aortic Repair (TEVAR) approach to restore blood flow. Conclusions: The case highlights the importance of prompt diagnosis and the effectiveness of TEVAR in addressing inadequate aortic remodeling.

BackgroundThis study aims to investigate the risk factors for in-hospital death in patients with acute aortic dissection (AAD) and to provide a straightforward prediction model to assist clinicians in determining the outcome of AAD patients.MethodsRetrospective analysis was carried out on 2,179 patients admitted for AAD from March 5, 1999 to April 20, 2018 in Wuhan Union Hospital, China. The risk factors were investigated with univariate and multivariable logistic regression analysis.ResultsThe patients were divided into two groups: Group A, 953patients (43.7%) with type A AAD; Group B, 1,226 patients (56.3%) with type B AAD. The overall in-hospital mortality rate was 20.3% (194/953) and 4% (50/1,226) in Group A and B respectively. The multivariable analysis included the variables that were statistically significant predictors of in-hospital death (P < 0.05). In Group A, hypotension (OR = 2.01, P = 0.001) and liver dysfunction (OR = 12.95, P < 0.001) were independent risk factors. Tachycardia (OR = 6.08, P < 0.001) and liver dysfunction (OR = 6.36, P < 0.05) were independent risk factors for Group B mortality. The risk factors of Group A were assigned a score equal to their coefficients, and the score of -0.5 was the best point of the risk prediction model. Based on this analysis, we derived a predictive model to help clinicians determine the prognosis of type A AAD patients.ConclusionsThis study investigate the independent factors associated with in-hospital death in patients with type A or B aortic dissection, respectively. In addition, we develop the prediction of the prognosis for type A patients and assist clinicians in choosing treatment strategies.

Abstract Introduction: cardiac blood cyst is a very rare benign tumor of the heart in adults. Though it is very common in the first half year of life, it regresses with time and its occurrence is very rare in children older than six months and in adults. Until now less than 100 valvular blood cysts have been reported in the literature. Case presentation: We present a case of 66 years old male presented with right leg weakness for two weeks. He was diagnosed with a cardiac mass two months ago in another hospital. The physical examination was unremarkable. Abdominal ultrasound showed a cyst in the liver and left kidney. Echocardiography showed a mass-occupying lesion of a cystic nature in the mitral valve with mild mitral regurgitation. Based on echo findings and abdominal ultrasound report the preliminary diagnosis of mitral valve blood cyst was made. The patient underwent total endoscopic resection of the cyst. The posterior mitral cusp was repaired and a mitral annuloplasty ring was placed. The postoperative recovery was uneventful. The histopathology report confirmed the diagnosis of cardiac blood cyst. The patient was followed up for six months without any complications. This case is presented here to enrich the already available medical literature of the cardiac blood cyst. Conclusion: The possibility of cardiac blood cyst increases with concomitant cyst present elsewhere in the body. Though cardiac blood cyst is a rare entity in adults, it should be considered in the differential diagnosis of cardiac tumors. Because the natural history and hemodynamic effect are very diverse, large symptomatic cardiac cysts, especially in the left heart should be resected to avoid complications.

Background:Controversy exists regarding the advantages and risks of off-pump vs. on-pump coronary artery bypass grafting (CABG) for patients with diabetes. We therefore compare the early clinical outcomes of off-pump vs. on-pump procedures for diabetic patients with three-vessel disease.Materials and methods:We conducted a retrospective analysis of clinical data obtained from 548 diabetic patients with three-vessel coronary artery disease who underwent isolated CABG between January 2016 and June 2020. To adjust the differences of baseline characteristics between the off-pump CABG (OPCAB) and on-pump CABG (ONCAB) groups, propensity score matching (PSM) was used. Following 1:1 matching, we selected 187 pairs of patients for further comparison of outcomes within the first 30 days after surgery.Results:The preoperative characteristics of the patients between the two groups were clinically comparable after PSM. The OPCAB group exhibited a significantly higher incidence of incomplete revascularization (27.3% vs. 14.4%; P = 0.002) compared with the ONCAB group. No differences were seen in mortality within 30 days between the matched groups (1.1% vs. 3.7%; P = 0.174). Notably, the OPCAB group had a lower risk of respiratory failure or infection (2.1% vs. 7.0%; P = 0.025), less postoperative stroke (1.1% vs. 4.8%; P = 0.032), and reduced postoperative ventilator assistance time (35.8 ± 33.7 vs. 50.9 ± 64.8; P = 0.005).Conclusion:OPCAB in diabetic patients with three-vessel disease is a safe procedure with reduced early stroke and respiratory complications and similar mortality rate, myocardial infarction, and renal failure requiring dialysis to conventional on-pump revascularization.

目的 评价重组人活化凝血因子Ⅶ(rFⅦa)对急性A型主动脉夹层(ATAAD)手术围手术期顽固性出血的治疗效果及对术后肺部感染并发症的影响.方法 收集2016年9月1日至2019年5月30日于华中科技大学同济医学院附属协和医院实施主动脉夹层手术的100例ATAAD患者的临床资料行回顾性分析.根据治疗方式的不同将患者分为rFⅦa组(65例)和对照组(35例).对照组仅接受常规治疗,rFⅦa组接受常规治疗及rFⅦa术中静脉输注治疗.对比分析2组患者的一般资料、临床效果指标及肺部感染并发症指标.结果 rFⅦa组体外循环时长长于对照组,差异有统计学意义(P<0.05).rFⅦa组术后24 h纵隔胸管引流量少于对照组,输注新鲜冰冻血浆量大于对照组,差异均有统计学意义[(370±161)ml比(489±267)ml、(650±355)ml比(465±347)ml](均P<0.05).2组机械通气时长、重症监护病房停留时长、住院时长、输注浓缩红细胞量、输注血小板量差异均无统计学意义(均P>0.05).rFⅦa组和对照组痰培养革兰阴性杆菌阳性率差异无统计学意义[43.1％(28/65)比37.1％(13/35)](P>0.05).结论 对于ATAAD患者围手术期顽固性出血,应用rFⅦa能够显著减少术后24 h引流量,但会增加体外循环时长和术后血液制品的输注,肺部感染并发症发生率与常规治疗相似.

BACKGROUND:A subset of patients require a tracheostomy as respiratory support in a severe state after cardiac surgery. There are limited data to assess the predictors for requiring postoperative tracheostomy (POT) in cardiac surgical patients. METHODS:The records of adult patients who underwent cardiac surgery from 2016 to 2019 at our institution were reviewed. Univariable analysis was used to assess the possible risk factors for POT. Then multivariable logistic regression analysis was performed to identify independent predictors. A predictive scoring model was established with predictor assigned scores derived from each regression coefficient divided by the smallest one. The area under the receiver operating characteristic curve and the Hosmer-Lemeshow goodness-of-fit test were used to evaluate the discrimination and calibration of the risk score, respectively. RESULTS:A total of 5,323 cardiac surgical patients were included, with 128 (2.4%) patients treated with tracheostomy after cardiac surgery. Patients with POT had a higher frequency of readmission to the intensive care unit (ICU), longer stay, and higher mortality (p < 0.001). Mixed valve surgery and coronary artery bypass grafting (CABG), aortic surgery, renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease (COPD), pulmonary edema, age >60 years, and emergent surgery were independent predictors. A 9-point risk score was generated based on the multivariable model, showing good discrimination [the concordance index (c-index): 0.837] and was well-calibrated. CONCLUSIONS:We established and verified a predictive scoring model for POT in patients who underwent cardiac surgery. The scoring model was conducive to risk stratification and may provide meaningful information for clinical decision-making.