Outcome after surgery for acute aortic dissection type A in young patients: Results from the German Registry for Acute Aortic Dissection type A (GERAADA)
Outcome after surgery for acute aortic dissection type A in young patients: Results from the German Registry for Acute Aortic Dissection type A (GERAADA)
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年轻患者急性 A 型主动脉夹层手术后的结果：来自德国 A 型急性主动脉夹层登记处 (GERAADA) 的结果
DOI：
10.1055/s-0031-1297445
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
E. Weigang
中科院分区：
文献类型：
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作者：
B. Rylski;I. Hoffmann;F. Beyersdorf;M. Suedkamp;M. Siepe;B. Nitsch;M. Blettner;E. Weigang
目的：急性 A 型主动脉夹层 (AADA) 在年轻人中很少见。随着社会老龄化，许多研究人员将重点放在分析老年患者上，因此很少有关于年轻 AADA 患者的公开数据。本研究的目的是分析年轻 AADA 患者的临床特征、当前治疗和手术结果。方法：2006 年 7 月至 2010 年 6 月期间，参与德国 A 型急性主动脉夹层登记 (GERAADA) 的 50 个中心总共报告了 2137 名患者。 160 名患者年龄在 40 岁以下，1977 名患者年龄在 40 岁及以上。我们比较了两组的临床特征和30天事件。结果：与≥40岁的患者相比，年轻患者更有可能患有马凡综合征（23% vs. 2%，p<0.0001），而高血压的可能性较小（28% vs. 55%，p<0.0001）。入院时，16% 的年轻患者出现心脏压塞，而老年患者这一比例为 20% (p= 0.2)。在年轻患者中，主动脉夹层更常见地延伸至主动脉上血管（41% vs. 37%，p = 0.4）。年轻患者也更有可能接受复杂的主动脉根部手术，即复合移植物植入（30% vs. 19%，p<0.001）和David手术（15% vs. 6%，p<0.0001）。年轻患者的主动脉瓣置换术频率较低（4% vs. 8%，p = 0.09）。两组术后 30 天死亡率均为 17%。两组因术后出血再次手术和术后新发灌注不良综合征的发生率相似（分别为 19% vs. 18% 和 10% vs. 11%）。年轻患者新发神经系统疾病的发生率较低（9% vs. 13%，p = 0.1），而且他们更常直接出院回家（26% vs. 14%，p < 0.001）。结论：年轻 AADA 患者的早期手术结果优于之前报道的结果。 AADA 的不同病因谱、主动脉夹层的扩展以及年轻患者更复杂的主动脉根部手术突显了这些患者的独特特征。
Objectives: Acute aortic dissection type A (AADA) is rare in young people. With our aging society, many investigators have focussed on analysing elderly patients, thus the paucity of published data on young patients with AADA. Aim of this study was to analyse clinical characteristics, current management, and surgical outcomes in young patients with AADA.Methods: Between 7/2006 and 6/2010, 50 centres participating in the German Registry for Acute Aortic Dissection Type A (GERAADA) reported a total of 2137 patients. 160 patients were under 40 years and 1977 patients were 40 years old and older. We compared the clinical features and 30-day events of both groups.Results: Compared with patients≥ 40 years, younger patients were more likely to have Marfan syndrome (23% vs. 2%, p< 0.0001), while hypertension was less likely (28% vs. 55%, p< 0.0001). On admission, 16% of younger patients had cardiac tamponade compared to 20% of older patients (p= 0.2). Aortic dissection extended to the supra-aortic vessels (41% vs. 37%, p= 0.4) more frequently in the younger patients. Younger patients were also more likely to undergo complex aortic-root surgery, ie composite graft implantation (30% vs. 19%, p< 0.001) and David operation (15% vs. 6%, p< 0.0001). Aortic valve replacement was done less frequently in the younger patients (4% vs. 8%, p= 0.09). Postoperative 30-day mortality was 17% in both groups. Both re-operation due to post-surgical bleeding and new onset of malperfusion syndrome after surgery occurred in both groups with similar frequency (19% vs. 18% and 10% vs. 11%, respectively). The incidence of new neurological disorders was lower in the younger patients (9% vs. 13%, p= 0.1), and they were more frequently discharged directly home (26% vs. 14%, p< 0.001).Conclusions: Early-term surgical outcomes in young patients with AADA are better than those previously reported. The varied aetiological spectrum of AADA, the extension of aortic dissection and more complex aortic root surgery in younger patients underscore the unique character of these patients.