Is advanced age a contraindication for emergent repair of acute type A aortic dissection?
Is advanced age a contraindication for emergent repair of acute type A aortic dissection?
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DOI：
10.1510/icvts.2009.222984
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发表时间：
2010-04-01
影响因子：
--
通讯作者：
Lobdell, Kevin W.
中科院分区：
文献类型：
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作者：
Stamou, Sotiris C.;Hagberg, Robert C.;Lobdell, Kevin W.
随着人类寿命的普遍延长，心脏外科医生面临着治疗越来越多的老年患者的问题。我们研究的目的是调查高龄是否会增加急性A型主动脉夹层修复术的主要发病率和死亡率。2000年至2008年间，119名患者在两个机构接受了急性A型主动脉夹层的急诊手术，其中90名年龄在70岁以下，29名患者年龄在70岁或以上。比较两组间的主要并发症、手术和5年精算生存率。手术死亡率为18.9%(70岁)，两组差异有统计学意义(P=0.6)。出血(70岁，P=0.09)、卒中(18.9%，P=0.79)、急性肾功能衰竭(70岁，22.2%，P=0.79)、机械通气时间延长(34.4%，P=0.36)再手术率两组间差异无统计学意义。70年患者的5年生存率为77%(P=0.07)。无论年龄大小，表现为血流动力学不稳定的患者的死亡率(71.4%)明显高于表现为血流动力学稳定的患者(23.9%，P<；0.001)。在70岁和年轻患者之间，手术死亡率、主要发病率和精算5年生存率没有显著差异，尽管在老年患者中有降低精算5年生存率的趋势。对于70岁或70岁以上的A型急性主动脉夹层患者，手术可以获得可接受的结果。无论年龄大小，血流动力学不稳定都预示着预后不良。(C)2010年，由欧洲心胸外科协会出版。版权所有。
With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The aim of our study was to investigate whether advanced age poses an increased risk for major morbidity and mortality with repair of acute type A aortic dissection. Between 2000 and 2008, 119 patients underwent emergency operation for acute type A aortic dissection at two institutions; 90 were younger than 70 years of age and 29 patients were 70 years or older. Major morbidity, operative and 5-year actuarial survival were compared between groups. The operative mortality rates were comparable between the two groups (18.9% in patients = 70 years, P = 0.6). There was no difference in the rates of reoperation for bleeding (= 70 years, P = 0.09), stroke (18.9% for those = 70 years, P = 0.79), acute renal failure (22.2% for those = 70 years, P = 0.79) or prolonged ventilation (34.4% for those = 70 years, P = 0.36) between the two groups. Actuarial 5-year survival rates were 77% for patients = 70 years (P = 0.07). The mortality for patients who presented with hemodynamic instability was markedly higher (10 out of 14 patients, 71.4%) compared with the mortality of those who presented with stable hemodynamics (21 out of 88 patients, 23.9%, P < 0.001), regardless of age group. No significant differences in operative mortality, major morbidity and actuarial 5-year survival were observed between patients >= 70 years and younger patients although there was a trend toward a lower actuarial 5-year survival in older patients. Surgery for type A acute aortic dissection in patients 70 years or older can be performed with acceptable outcomes. Hemodynamic instability portends a poor prognosis, regardless of age. (c) 2010 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.