Department of Surgery, Section of Cardiothoracic Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA.
J Thorac Cardiovasc Surg. 2013 Mar;145(3 Suppl):S186-90. doi: 10.1016/j.jtcvs.2012.11.060. Epub 2012 Dec 23.
Surgery in octogenarians with acute type A aortic dissection is commonly avoided or denied because of the high surgical morbidity and mortality reported in elderly patients. We sought to compare clinical and quality of life outcomes between octogenarians and those aged less than 80 years who underwent surgical repair at New York Medical College.
A total of 101 cases of acute type A aortic dissection repair between July 2005 and December 2011 were retrospectively analyzed, comparing 21 octogenarians with 80 concurrent patients aged less than 80 years. All patients underwent corrective surgery (ascending/hemiarch replacement in 71; Bentall in 22; David procedure in 2; Wheat procedure in 4; total arch replacement in 2) using deep hypothermic circulatory arrest. During follow-up, the RAND 36-Item Short Form Health Survey Questionnaire was used to assess quality of life.
Octogenarians (average, 85 years; range, 80-91 years) were compared with the younger group (average, 60 years; range, 30-79 years). The 2 groups had similar preoperative characteristics, but the younger group experienced more malperfusion (40% vs 9%, P = .002), were more likely to have undergone a Bentall procedure (26% vs 5%, P = .04), and had longer circulatory arrest times (20 ± 7 minutes vs 16 ± 9 minutes, P = .03). The overall hospital mortality was 9% (9/101). Among octogenarians, there were no hospital deaths, no late deaths during follow-up (mean, 17 months; range, 1-59 months), and emotional health scores were better than those of the younger patients (P = .04).
Surgery for acute type A aortic dissection should be offered to octogenarians because excellent surgical and quality of life outcomes can be achieved even in this elderly population.
由于高龄患者手术发病率和死亡率较高，80 岁以上急性 A 型主动脉夹层患者通常避免或拒绝手术。我们旨在比较纽约医学院接受手术修复的 80 岁以上和 80 岁以下患者的临床和生活质量结局。
回顾性分析了 2005 年 7 月至 2011 年 12 月期间 101 例急性 A 型主动脉夹层修复病例，比较了 21 例 80 岁以上高龄患者和 80 例同期 80 岁以下患者。所有患者均接受深低温停循环下的矫正手术（71 例行升主动脉/半弓置换；22 例行 Bentall 手术；2 例行 David 手术；4 例行 Wheat 手术；2 例行全主动脉弓置换）。在随访期间，使用 RAND 36 项简明健康调查问卷评估生活质量。
80 岁以上高龄组（平均年龄 85 岁；范围 80-91 岁）与年轻组（平均年龄 60 岁；范围 30-79 岁）比较。两组术前特征相似，但年轻组灌注不良发生率更高（40%比 9%，P=0.002），更可能接受 Bentall 手术（26%比 5%，P=0.04），且体外循环时间更长（20±7 分钟比 16±9 分钟，P=0.03）。总的院内死亡率为 9%（9/101）。80 岁以上高龄组无院内死亡，随访期间无晚期死亡（平均 17 个月；范围 1-59 个月），且情绪健康评分优于年轻患者（P=0.04）。
急性 A 型主动脉夹层手术应向 80 岁以上患者提供，因为即使在老年人群中也能获得极好的手术和生活质量结局。
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