13年a型急性主动脉综合征手术治疗队列中的类型输入灌注不良分类：对计划和结果的影响
Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes.
摘要(中文译文)
斯坦福分类有助于快速分诊A型急性主动脉综合征患者，但忽略了近端入口撕裂和灌注不良等关键要素。较新的分型、入口、灌注不良分类弥补了这些不足，以改善管理。我们开展了一项回顾性单中心研究，纳入2010年至2023年间所有因A型急性主动脉综合征接受手术的患者。在334例纳入患者中，院内死亡率为16.5%。入口撕裂位于升主动脉者占69%，位于主动脉弓者占19%，位于降主动脉者占3.6%。75%的患者发生灌注不良；35%的患者至少有1处临床灌注不良。弓部或远端入口撕裂与更广泛的弓部切除显著相关。冠状动脉灌注不良导致更多相关手术（冠状动脉旁路移植术、再植入术），更频繁的根部置换（M1-），以及更多的体外生命支持使用（M1+）。临床灌注不良与更高的死亡率和并发症发生率相关。M3+患者表现出最严重的多器官并发症。分型、入口、灌注不良分类提供了有价值的术前信息，有助于预判手术策略并识别高危患者。然而，其区分灌注不良严重程度的能力仍然有限。
Abstract
The Stanford classification helps rapidly triage patients with type A acute aortic syndrome, but it overlooks key elements like proximal entry tear and malperfusion. The newer type, entry, malperfusion classification addresses these gaps to improve management. We conducted a retrospective monocentric study of all patients operated for type A acute aortic syndrome between 2010 and 2023. Among 334 included patients, hospital mortality was 16.5%. Entry tear was located in the ascending aorta in 69%, the arch in 19%, and the descending aorta in 3.6%. Malperfusion occurred in 75% of patients; 35% had at least 1 clinical malperfusion. Arch or distal entry tears were significantly associated with more extensive arch resections. Coronary malperfusion led to more associated procedures (coronary artery bypass grafting, reimplantation), more frequent root replacements (M1-), and greater extracorporeal life support use (M1+). Clinical malperfusions were associated with greater mortality and complication rates. Patients who were M3+ displayed the most severe multiorgan complications. The type, entry, malperfusion classification offers valuable preoperative insights, helping to anticipate surgical strategy and identify high-risk patients. However, its ability to differentiate malperfusion severity remains limited.
如何引用
AMA
Jacques Tomasi, Pierre Escrig, Jean Philippe Verhoye. Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes.. JTCVS open. 2026; doi:10.1016/j.xjon.2026.101614.
APA
Jacques Tomasi, Pierre Escrig, Jean Philippe Verhoye (2026). Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes.. JTCVS open. https://doi.org/10.1016/j.xjon.2026.101614
GB/T 7714
Jacques Tomasi, Pierre Escrig, Jean Philippe Verhoye. Type-entry-malperfusion classification in a 13-year cohort of surgically treated type A acute aortic syndromes: Impact on planning and outcomes.[J]. JTCVS open, 2026 doi:10.1016/j.xjon.2026.101614.
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