Castaño Mario, Gualis Javier, Martínez-Comendador Jose M, Martín Elio, Maiorano Pasquale, Castillo Laura
Department of Cardiac Surgery, University Hospital of Leon, León, Spain.
J Thorac Dis. 2017 May;9(Suppl 6):S498-S507. doi: 10.21037/jtd.2017.04.51.
Surgery of both the ascending and descending aortic segments in the context of an acute aortic syndrome is one of the greatest challenges for the cardiac surgeon. In the case of surgery of the descending aorta, surgical risk increases due to the technical complexity, the required aggressive approach and because surgical indication is usually established as a result of complications and therefore involves, almost always, critically ill patients. The aging of the population is causing such surgery to be considered in an increasing number of octogenarians. The present review analyzes the available scientific evidence on the surgical indications and outcomes of these complex procedures in this population, particularly in the emergent scenario. Ascending and descending thoracic aortic diseases are reviewed separately, and the role of both the current risk scores and frailty assessments are comprehensively discussed.
在急性主动脉综合征的背景下，升主动脉和降主动脉节段的手术是心脏外科医生面临的最大挑战之一。对于降主动脉手术，由于技术复杂性、所需的积极手术方式以及手术指征通常是由于并发症而确定的，因此几乎总是涉及重症患者，手术风险会增加。人口老龄化导致越来越多的八旬老人接受此类手术。本综述分析了关于这一人群中这些复杂手术的手术指征和结果的现有科学证据，特别是在紧急情况下。分别回顾了升主动脉和降主动脉疾病，并全面讨论了当前风险评分和衰弱评估的作用。
