Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA.
J Thorac Cardiovasc Surg. 2013 May;145(5):1242-7. doi: 10.1016/j.jtcvs.2012.05.005. Epub 2012 Jun 12.
Thoracic endovascular aortic repair, although physiologically well tolerated, may fail to confer significant survival benefit in some high-risk patients. In an effort to identify patients most likely to benefit from intervention, the present study sought to determine the risk factors for 1-year mortality after thoracic endovascular aortic repair.
A retrospective review was performed on prospectively collected data from all patients undergoing thoracic endovascular aortic repair from 2002 to 2010 at a single institution. Univariate analysis and multivariate Cox proportional hazards regression analysis were used to identify risk factors associated with mortality within 1 year after thoracic endovascular aortic repair.
During the study period, 282 patients underwent at least 1 thoracic endovascular aortic repair; index procedures included descending aortic repair (n = 189), hybrid arch repair (n = 55), and hybrid thoracoabdominal repair (n = 38). The 30-day/in-hospital mortality was 7.4% (n = 21) and the overall 1-year mortality was 19% (n = 54). Cardiopulmonary pathologies were the most common cause of nonperioperative 1-year mortality (22%, n = 12). Multivariate modeling demonstrated 3 variables independently associated with 1-year mortality: age older than 75 years (hazard ratio, 2.26; P = .005), aortic diameter greater than 6.5 cm (hazard ratio, 2.20; P = .007), and American Society of Anesthesiologists class 4 (hazard ratio, 1.85; P = .049). A baseline creatinine greater than 1.5 mg/dL (hazard ratio, 1.79; P = .05) and congestive heart failure (hazard ratio, 1.87; P = .08) were also retained in the final model. These 5 variables explained a large proportion of the risk of 1-year mortality (C statistic = 0.74).
Age older than 75 years, aortic diameter greater than 6.5 cm, and American Society of Anesthesiologists class 4 are independently associated with 1-year mortality after thoracic endovascular aortic repair. These clinical characteristics may help risk-stratify patients undergoing thoracic endovascular aortic repair and identify those unlikely to derive a long-term survival benefit from the procedure.
尽管胸主动脉腔内修复术在生理上能很好地耐受，但在某些高危患者中，它可能无法带来显著的生存获益。为了确定最有可能从介入治疗中获益的患者，本研究旨在确定胸主动脉腔内修复术后 1 年内死亡的危险因素。
对 2002 年至 2010 年在一家单中心接受胸主动脉腔内修复术的所有患者的前瞻性收集数据进行回顾性分析。采用单因素分析和多因素 Cox 比例风险回归分析确定与胸主动脉腔内修复术后 1 年内死亡相关的危险因素。
在研究期间，282 例患者至少接受了 1 次胸主动脉腔内修复术；索引手术包括降主动脉修复（n=189）、杂交弓修复（n=55）和杂交胸腹主动脉修复（n=38）。30 天/住院死亡率为 7.4%（n=21），总 1 年死亡率为 19%（n=54）。心肺疾病是术后 1 年非死亡的最常见原因（22%，n=12）。多变量建模显示 3 个变量与 1 年死亡率独立相关：年龄大于 75 岁（风险比，2.26；P=0.005）、主动脉直径大于 6.5cm（风险比，2.20；P=0.007）和美国麻醉医师协会分级 4（风险比，1.85；P=0.049）。基线肌酐大于 1.5mg/dL（风险比，1.79；P=0.05）和充血性心力衰竭（风险比，1.87；P=0.08）也保留在最终模型中。这 5 个变量解释了 1 年死亡率的很大一部分风险（C 统计量=0.74）。
年龄大于 75 岁、主动脉直径大于 6.5cm 和美国麻醉医师协会分级 4 与胸主动脉腔内修复术后 1 年死亡率独立相关。这些临床特征可能有助于对接受胸主动脉腔内修复术的患者进行风险分层，并确定那些不太可能从该手术中获得长期生存获益的患者。
