Aortic arch surgery in octogenarians: is it justified?
Aortic arch surgery in octogenarians: is it justified?
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DOI：
10.1093/ejcts/ezu056
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发表时间：
2014-10-01
影响因子：
3.4
通讯作者：
Hamano, Kimikazu
中科院分区：
文献类型：
--
作者：
Kurazumi, Hiroshi;Mikamo, Akihito;Hamano, Kimikazu
目的：老年患者有时拒绝主动脉弓手术，因为认为结果不佳和生活质量（QOL）不可接受。在这项研究中，我们评估了早期的临床结果，长期生存和QOL手术治疗后主动脉弓疾病在acadegenarian patients.METHODS：共47个连续的患者年龄在80岁以上被称为我们的机构。在这些患者中，20例接受手术干预（手术组），27例接受药物治疗（药物组）。对两组进行Kaplan-Meier生存分析，并与年龄匹配的人群数据进行比较。采用考克斯回归分析确定死亡率的危险因素。使用36项简明健康调查表进行QOL评估。结果：两组患者基线特征无显著差异。15例行常规全主动脉弓置换术，2例行胸主动脉腔内修复术，3例行烟囱式主动脉腔内修复术。对3例患者进行了紧急手术。手术组无院内死亡。2例患者因出血需要再次手术，4例患者需要延长机械通气。手术组5年生存率为61.5%，内科组为14.2%（P = 0.02）。手术组5年时无血栓相关死亡率为92.3%，药物组为32.3%（P = 0.01）。接受手术治疗的患者与性别和年龄匹配的人群之间的5年生存率无差异（P = 0.80），而接受药物治疗的患者的5年生存率明显低于性别和年龄匹配的人群（P < 0.001）。药物治疗是死亡的唯一危险因素（风险比：3.16，P = 0.04）。在中期的幸存者中，生活质量的措施之间的手术组和那些在medical group.CONCLUSIONS：主动脉弓疾病的外科干预，可以产生令人满意的早期临床结果和可接受的中期生存与足够的日常活动。这项研究表明，在八十多岁的人中，仅凭年龄不应取消患者接受主动脉弓介入治疗的资格。
OBJECTIVES: Elderly patients are sometimes denied aortic arch surgery because of the perception of poor outcomes and an unacceptable quality of life (QOL). In this study, we evaluated the early clinical outcomes, long-term survival and QOL following surgical treatment for aortic arch disease in octogenarian patients.METHODS: A total of 47 consecutive patients over the age of 80 years were referred to our institutions. Of these patients, 20 underwent surgical intervention (surgical group) and 27 were treated medically (medical group). Kaplan-Meier survival analysis was performed between the two groups, and the results were compared with age-matched population data. The risk factors for mortality were determined using a Cox regression analysis. A QOL assessment was performed using the 36-item Short Form Health Survey.RESULTS: The patient characteristics at baseline were not significantly different between the two groups. In the surgical cases, conventional total aortic arch replacement was performed in 15 patients, debranched thoracic endovascular aortic repair (TEVAR) in 2 and chimney TEVAR in 3. Emergency procedures were performed in 3 patients. No hospital deaths occurred in the surgical groups. Reoperation for bleeding was required in 2 patients, and prolonged mechanical ventilation was required in 4 patients. The 5-year survival was 61.5% in the surgical group and 14.2% in the medical group (P = 0.02). Freedom from aorta-related death at 5 years was 92.3% in the surgical group and 32.3% in the medical group (P = 0.01). There were no differences in the 5-year survival between patients undergoing surgical intervention and the sex-and age-matched population (P = 0.80), whereas the 5-year survival was significantly lower in patients who received medical therapy relative to the sex-and age-matched population (P < 0.001). Medical therapy was the sole risk factor for mortality (hazard ratio: 3.16, P = 0.04). Among the survivors at mid-term, the quality-of-life measures were similar between those in the surgical group and those in the medical group.CONCLUSIONS: Surgical intervention for aortic arch disease in octogenarians can yield satisfactory early clinical outcomes and acceptable mid-term survival with adequate daily activity. This study indicates that among octogenarians, age alone should not disqualify a patient from receiving an aortic arch intervention.