Tochii Masato, Takami Yoshiyuki, Hattori Koji, Ishikawa Hiroshi, Ishida Michiko, Higuchi Yoshiro, Takagi Yasushi
Department of Cardiovascular Surgery, Fujita Health University.
Circ J. 2016 Nov 25;80(12):2468-2472. doi: 10.1253/circj.CJ-16-0918. Epub 2016 Nov 1.
Because increased age is a strong independent predictor of mortality and morbidity, surgery for octogenarians with Stanford type A aortic dissection (AAD) may be avoided.
From 2005 to 2015, 158 patients underwent surgical repair for AAD via a median sternotomy. We compared 24 (15.2%) octogenarians (83±3 years) with 134 (84.8%) patients aged ≤79 years (62±13 years), based on retrospectively collected clinical data. Octogenarians were predominantly female (79.2% vs. 44.8%, P=0.0033). Ascending aortic replacement was more frequently performed in the octogenarians (95.8% vs. 65.7%, P=0.0015) and total arch replacement in the younger patients (4.2% vs. 26.9%, P=0.0165). There were 14 hospital deaths among the younger patients, none among the octogenarians (0% vs. 10.4%, P=0.1303), and major morbidity rates were comparable. There were 3 late deaths among the octogenarians and 9 deaths among the younger patients. The respective 1-, 3-, and 5-year survival rates were 94.4%, 81.5%, and 81.5% in the octogenarians and 86.9%, 85.6%, and 83.9% in the younger patients, with no significant differences.
Surgical repair for AAD in octogenarians showed favorable results when compared with a younger patient cohort, with low hospital mortality rate and excellent late outcomes. Therefore, this technique should not be disregarded just because the patient is an octogenarian. (Circ J 2016; 80: 2468-2472).
由于年龄增长是死亡率和发病率的强有力独立预测因素，对于患有A型主动脉夹层（AAD）的八旬老人，可能会避免进行手术。
2005年至2015年期间，158例患者通过正中胸骨切开术接受了AAD手术修复。我们根据回顾性收集的临床数据，将24例（15.2%）八旬老人（83±3岁）与134例（84.8%）年龄≤79岁（62±13岁）的患者进行了比较。八旬老人以女性为主（79.2%对44.8%，P=0.0033）。八旬老人更常进行升主动脉置换（95.8%对65.7%，P=0.0015），而年轻患者更常进行全弓置换（4.2%对26.9%，P=0.0165）。年轻患者中有14例住院死亡，八旬老人中无住院死亡（0%对10.4%，P=0.1303），且主要发病率相当。八旬老人中有3例晚期死亡，年轻患者中有9例死亡。八旬老人的1年、3年和5年生存率分别为94.4%、81.5%和81.5%，年轻患者分别为86.9%、85.6%和83.9%，差异无统计学意义。
与年轻患者队列相比，八旬老人AAD手术修复显示出良好结果，住院死亡率低且晚期预后良好。因此，不应仅仅因为患者是八旬老人就忽视这项技术。（《循环杂志》2016年；80：2468 - 2472）
