Survival after surgery for acute type A aortic dissection in octogenarians
Antonio Fiore1
Javier Rodriguez Lega2
Joscha Buech3
Giovanni Mariscalco4
Andrea Per-rotti5
Konrad Wisniewski6
Angel G.Pinto2
Till Demal7
Jan Rocek8
Petr Kacer8
Giuseppe Gatti9
Igor Vendramin10
Mauro Rinaldi11
Eduard Quintana12
Dario Di Perna13
Francesco Nappi14
Mark Field15
Amer Harky15
Matteo Pettinari16
Angelo M.Dell'Aquila17
Francesco Onorati18
Mikko Jormalainen19
Tatu Juvonen20
Timo Mäkikallio21
Caroline Radner3
Sven Peterss22
Vito D'Andrea23
Fausto Biancari24
1.Department of Cardiac Surgery,Hôpitaux Universitaires Henri Mondor,Creteil,France2.Cardiovascular Surgery Department,University Hospital Gregorio Marañón,Madrid,Spain3.LMU University Hospital,Ludwig Maximilian University,Munich,Germany;German Centre for Cardiovascular Research,Partner Site Munich Heart Alliance,Mu-nich,Germany4.Department of Cardiac Surgery,Glenfield Hospital,Leicester,United Kingdom5.Department of Thoracic and Cardiovascular Surgery,University of Franche-Comte,Besancon,France6.Department of Cardiothoracic Surgery,University Hospital Muenster,Muenster,Germany7.Department of Cardiovascular Surgery,University Heart and Vascular Center Hamburg,Hamburg,Germany8.Department of Cardiac Surgery,Charles University and University Hospital Kralovske Vinohrady,Prague,Czech Republic9.Division of Cardiac Surgery,Cardio-thoracic and Vascular Department,Azienda Sanitaria Universitaria Giuliano Isontina,Trieste,Italy10.Cardiothoracic Department,University Hospital,Udine,Italy11.Cardiac Surgery,Molinette Hospital,University of Turin,Turin,Italy12.Depart-ment of Cardiovascular Surgery,Hospital Clínic de Barcelona,University of Barcelona,Barcelona,Spain13.Depart-ment of Cardiac Surgery,Centre Hospitalier Annecy Genevois,Epagny Metz-Tessy,France14.Department of Cardiac Surgery,Centre Cardiologique du Nord de Saint-Denis,Paris,France15.Liverpool Centre for Cardiovascular Sciences,Liverpool Heart and Chest Hospital,Liverpool,United Kingdom16.Department of Cardiac Surgery,Ziekenhuis Oost Limburg,Genk,Belgium,and Département Cardiovasculair,Cliniques Universitaries Saint Luc,Bruxelles,Belgium17.Department of Cardiac surgery,Martin Luther University Halle-Wittenberg,Halle,Germany18.Division of Cardi-ac Surgery,University of Verona Medical School,Verona,Italy19.Faculty of Medicine,University of Oulu,Oulu,Fin-land20.Faculty of Medicine,University of Oulu,Oulu,Fin-land;Heart and Lung Center,Helsinki University Central Hospital,University of Helsinki,Helsinki,Finland21.De-partment of Medicine,South-Karelia Central Hospital,University of Helsinki,Lappeenranta,Finland22.LMU University Hospital,Ludwig Maximilian University,Munich,Germany23.Department of Surgical Sciences,Sapienza University of Rome,Rome,Italy24.Department of Cardiovascular Surgery,Centro Cardi-ologico Monzino IRCCS,Milan,Italy
摘要：Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.
Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissec-tion(ERTAAD)were the subjects of the present analysis.
Results 326(8.4％)patients were aged ≥ 80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0％in patients aged ≥ 80 years and 20.0％in younger patients(P=0.006),while 10-year mortality were 93.2％and 48.0％,respectively(P＜0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged＜80 years,and 0.46 in patients aged ≥ 80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age ≥ 85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score＜1 was observed in 68.4％of patients,and their in-hospital mortality was 20.9％.
Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the West-ern countries.
机标关键词：surgeryafteracuteaorticdissectionoctogenarianssurvivaltype
论文发表日期：2024-11-28
在线出版日期：2025-08-15（本平台首次上网日期，不代表文献的发表时间）
页数：11( 1015-1025 )