关键词: 急性Stanford A型主动脉夹层, 术后新发房颤, 心脏外科手术, 心肌保护, 心肌停搏液

Abstract: Objective To investigate the correlation between myocardial protection solution infusion strategies and the occurrence of new-onset postoperative atrial fibrillation in patients with acute Stanford type A aortic dissection(AAAD), with the aim of reducing the incidence of atrial fibrillation. Methods This retrospective study included 207 patients diagnosed with AAAD at Drum Tower Hospital from January 1, 2020, to December 31, 2024. Patients were categorized into an antegrade cardioplegia group(n=121)and a retrograde cardioplegia group(n=86)based on the myocardial protection solution infusion strategy. The primary endpoint was the incidence of new-onset atrial fibrillation, and secondary endpoints included mechanical ventilation duration and Intensive Care Unit(ICU)stay. Multivariate logistic regression analysis was used to assess the correlation between myocardial protection solution infusion strategy and new-onset atrial fibrillation, and three propensity score methods were used for adjustment. Subgroup analyses were conducted on different surgical methods, and the number needed to treat was analyzed. In addition, multivariate logistic regression analysis was used to explore the independent risk factors for new-onset atrial fibrillation after AAAD. Results The overall incidence of atrial fibrillation was 38.65%, showing no significant statistical difference between the two groups(39.67% vs. 37.21%, P=0.831). Regarding secondary endpoints, there was no statistically significant difference in the duration of mechanical ventilation on a ventilator between the antegrade perfusion group and the retrograde perfusion group(27.00 h vs. 21.50 h, P=0.075). However, the ICU stay in the antegrade perfusion group was shorter than that in the retrograde perfusion group, and the different was statistically significant(128.00 h vs. 160.50 h, P=0.012). Multivariate logistic regression and propensity score adjustment analyses also did not show a significant correlation between myocardial protection solution infusion methods and the incidence of new-onset atrial fibrillation(P>0.05). Subgroup analysis revealed no significant difference in atrial fibrillation occurrence between the two infusion methods. The analysis of the number of patients benefiting from treatment also did not find that different perfusion methods brought clinical benefits to the new-onset atrial fibrillation after surgery( number needed to treat: 40, 95%CI: -9-6). In addition, multivariate logistic regression analysis showed that advanced age(OR=1.08,95%CI:1.03-1.14,P=0.003), suffering from coronary heart disease(OR=2.45,95%CI:1.28-4.69,P=0.007), longer operation time(OR=1.02,95%CI:1.01-1.04,P=0.032)and longer ICU stay(OR=1.15,95%CI:1.06-1.25,P=0.011)were independent risk factors for new-onset atrial fibrillation after AAAD surgery. Conclusion In patients with AAAD, there is no significant correlation between myocardial protection solution infusion strategy and the incidence of new-onset atrial fibrillation. Antegrade cardioplegia can be recommended as the standard strategy. However, given that advanced age, comorbid coronary artery disease, prolonged operative duration, and extended ICU stay are independent risk factors, the choice of cardioplegia strategy should still be individualized.

Key words: Acute stanford type A aortic dissection, New-onset atrial fibrillation, Cardiothoracic surgery, Myocardial protection strategies, Myocardial cardioplegia