Piccardo Alessandro, Regesta Tommaso, Zannis Konstantinos, Gariboldi Vlad, Pansini Stefano, Tapia Michel, Concistré Giovanni, Collart Frédéric, Kreitmann Patrice, Kirsch Matthias E W, Martinelli Luigi, Passerone Giancarlo, Caus Thierry
Amiens Picardie University Hospital, Amiens, France.
Ann Thorac Surg. 2009 Aug;88(2):491-7. doi: 10.1016/j.athoracsur.2009.04.096.
Management of octogenarian patients with acute type A acute aortic dissection is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.
Beginning January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 57 consecutive patients enrolled up to December 2006. Their median age was 82 (range, 80 to 89 years). Compassionate indication operations were attempted in 2 moribund patients and in 5 presenting with shock associated with neurologic symptoms or renal failure, or both. Operations followed the standard procedure recommended in younger patients. Follow-up was 100% complete (mean, 3.9 +/- 2 years; range, 5 months to 8 years).
There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication (p < or = 0.0001) and total arch replacement (p = 0.0060) as risk factors for in-hospital mortality. Postoperative complications occurred in 36 patients (69.2%) and were associated with a higher mortality (p = 0.0001). Overall survival was 51% at 1 year and 44% at 5 years. Excluding patients with compassionate indication and those who underwent total arch replacement, or both, overall survival was 66% at 1 year and 57% at 5 years.
Surgical treatment for type A acute aortic dissection in octogenarians shows satisfactory midterm results among survivors. However, the high mortality rate imposes a requirement for better perioperative management. Compassionate cases should be managed medically. A less aggressive approach should improve outcomes of surgical treatment.
老年急性A型主动脉夹层患者的治疗存在争议。本研究分析了手术结果，以确定应接受手术的患者。
从2000年1月开始，我们建立了一个登记册，纳入所有接受急性A型主动脉夹层手术的老年患者。我们评估了截至2006年12月连续入组的57例患者。他们的中位年龄为82岁（范围80至89岁）。对2例濒死患者以及5例伴有神经症状或肾衰竭或两者皆有的休克患者尝试进行了同情性指征手术。手术遵循年轻患者推荐的标准程序。随访率为100%（平均3.9±2年；范围5个月至8年）。
有26例（45.6%）院内死亡和6例晚期死亡。多因素分析确定同情性指征（p≤0.0001）和全弓置换（p = 0.0060）为院内死亡的危险因素。36例患者（69.2%）发生术后并发症，且并发症与较高的死亡率相关（p = 0.0001）。1年时总体生存率为51%，5年时为44%。排除有同情性指征的患者以及接受全弓置换或两者皆有的患者后，1年时总体生存率为66%，5年时为57%。
老年急性A型主动脉夹层的手术治疗在幸存者中显示出令人满意的中期结果。然而，高死亡率要求更好的围手术期管理。同情性病例应采用内科治疗。采用不太激进的方法应能改善手术治疗效果。
