Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis
Impact of Medical Therapy on Late Morbidity and Mortality After Aortic Aneurysm Repair for Aortitis
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DOI：
10.1016/j.athoracsur.2018.01.009
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发表时间：
2018-06-01
影响因子：
4.6
通讯作者：
Schaff, Hartzell V.
中科院分区：
文献类型：
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作者：
Prasad, Anjali;Helder, Meghana R. K.;Schaff, Hartzell V.
背景患有活动性动脉炎的患者接受升主动脉瘤修复后，晚期再手术的风险增加，晚期生存率降低。我们的目的是确定这些不良结果的原因和医疗管理的影响。我们回顾了186例择期升主动脉瘤修复术后（1955年1月至2012年12月）非感染性腹膜炎患者（中位年龄73.9岁; 120例女性）的记录。采用标志性分析比较单纯性乳腺炎与全身性乳腺炎后遗症患者的预后沿着糖皮质激素治疗的预后。15年时，总体死亡率为88.3%; 10年时，总体再手术率为28.2%。手术时年龄越大，长期死亡率越高（风险比[HR] 1.62，95%置信区间[CI]：1.25至2.11，p < 0.001），冠心病（HR 1.94，95% CI：1.25 - 3.01，p = 0.003），外周血管疾病（HR 1.79，95% CI：1.09至2.94，p = 0.02）和术前疑似乳腺炎（HR 4.90，95% CI：1.96至12.26，p < 0.001）。再手术率增加与冠状动脉疾病（HR 2.69，95% CI：1.17至6.17，p = 0.02）和外周血管疾病（HR 3.92，95% CI：1.71至8.94，p = 0.001）相关。在6个月时无再次手术的患者中，发现乳腺炎的全身后遗症显著，未校正的风险比为3.59（95% CI：1.40至9.18，p = 0.008）。糖皮质激素治疗与随后的死亡率或再次手术无关。继发于心内膜炎的全身性疾病的发展与晚期主动脉再次手术的风险增加相关。然而，糖皮质激素治疗非感染性乳腺炎并没有明显影响生存率或再次手术的需要。(C)2018胸外科医师协会
Background. Patients with active aortitis who undergo repair of ascending aortic aneurysms have an increased risk of late reoperation and decreased late survival. We aimed to determine the reasons for these poor outcomes and the influence of medical management.Methods. We reviewed records of 186 patients (median age 73.9 years; 120 women) with noninfectious aortitis after elective ascending aortic aneurysm repair (January 1955 through December 2012). Landmark analysis was used to compare outcomes in patients with isolated aortitis versus with systemic sequelae of aortitis along with outcomes of treatment with glucocorticoids.Results. At 15 years, the overall mortality was 88.3%; at 10 years, the overall reoperation rate was 28.2%. Long-term mortality increased with older age at surgery (hazard ratio [HR] 1.62, 95% confidence interval [CI]: 1.25 to 2.11, p < 0.001), coronary artery disease (HR 1.94, 95% CI: 1.25 to 3.01, p = 0.003), peripheral vascular disease (HR 1.79, 95% CI: 1.09 to 2.94, p = 0.02), and preoperative suspicion of aortitis (HR 4.90, 95% CI: 1.96 to 12.26, p < 0.001). Increased reoperation rate was associated with coronary artery disease (HR 2.69, 95% CI: 1.17 to 6.17, p = 0.02) and peripheral vascular disease (HR 3.92, 95% CI: 1.71 to 8.94, p = 0.001). Among patients free of reoperation at 6 months, systemic sequelae of aortitis were found to be significant, with an unadjusted hazard ratio of 3.59 (95% CI: 1.40 to 9.18, p = 0.008). Treatment with glucocorticoids was not associated with subsequent mortality or reoperation.Conclusions. The development of systemic illness secondary to aortitis was associated with increased risk of late aortic reoperations. However, glucocorticoid treatment of noninfectious aortitis did not clearly influence survival or need for reoperation. (C) 2018 by The Society of Thoracic Surgeons