Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX, USA.
Am J Surg. 2009 Dec;198(6):889-94. doi: 10.1016/j.amjsurg.2009.04.034.
We evaluated contemporary outcomes of open thoracic aortic surgery at a Veterans Affairs (VA) medical center affiliated with a major academic aortic program and examined the predictive value of 2 established cardiac risk models.
We retrospectively reviewed all open thoracic aortic operations performed between April 1998 and April 2008 (n = 100). Both the EuroSCORE and the VA Continuous Improvement in Cardiac Surgery Program (CICSP) scores were evaluated.
Procedures included ascending aortic repair (n = 74, 15 with arch repair), descending thoracic repair (n = 11, 1 with arch repair), and thoracoabdominal aortic repair (n = 15). Emergency surgery was necessary in 15 cases, and 19 procedures were reoperations. The patients' logistic EuroSCORE and the CICSP scores were similar (18.7% and 18.2%, respectively), but both scores significantly exceeded the observed operative mortality rate (8.0%, P = .008).
Good outcomes can be achieved when thoracic aortic surgery is performed at an experienced VA center. The cardiac risk models we examined overpredicted operative mortality.
我们评估了退伍军人事务部（VA）医疗中心与主要学术主动脉计划相关联的开胸主动脉手术的当代结果，并研究了两种已建立的心脏风险模型的预测价值。
我们回顾性地审查了 1998 年 4 月至 2008 年 4 月期间进行的所有开胸主动脉手术（n = 100）。评估了 EuroSCORE 和 VA 心脏手术持续改进计划（CICSP）评分。
手术包括升主动脉修复（n = 74，其中 15 例伴有弓部修复），降主动脉修复（n = 11，其中 1 例伴有弓部修复）和胸腹主动脉修复（n = 15）。15 例需要急诊手术，19 例为再次手术。患者的逻辑 EuroSCORE 和 CICSP 评分相似（分别为 18.7%和 18.2%），但两者的评分均显著高于观察到的手术死亡率（8.0%，P =.008）。
在经验丰富的 VA 中心进行胸主动脉手术可以获得良好的结果。我们检查的心脏风险模型过高预测了手术死亡率。
