Merkle Julia, Sabashnikov Anton, Weber Carolyn, Schlachtenberger Georg, Maier Johanna, Spieker Anna, Eghbalzadeh Kaveh, Deppe Antje-Christin, Zeriouh Mohamed, Rahmanian Parwis B, Madershahian Navid, Rustenbach Christian, Choi Yeong-Hoon, Kuhn-Régnier Ferdinand, Liakopoulos Oliver, Wahlers Thorsten
Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany.
Perfusion. 2018 Nov;33(8):687-695. doi: 10.1177/0267659118786332. Epub 2018 Jul 11.
Stanford A acute aortic dissection (AAD) is a life-threatening emergency, typically occurring in older patients and requiring immediate surgical repair. The aim of this study was to evaluate early outcome and short- and long-term survival of patients under and above 65 years of age.
Two hundred and forty patients with Stanford A AAD underwent aortic surgical repair from January 2006 to April 2015 in our center. After statistical analysis and logistic regression analysis, Kaplan-Meier survival estimation was performed, with up to 9-year follow-up, comprising patients under and above 65 years of age.
The proportion of patients above 65 years of age suffering from Stanford A AAD was 50% (n=120). The group of patients above 65 years of age compared to the group under 65 years of age showed statistically significant differences in terms of higher odds ratios (OR) for hypertension (p=0.012), peripheral vascular disease (p=0.026) and tachyarrhythmia absoluta (p=0.004). Patients over 65 years of age also showed significantly poorer short- and long-term survival. Our subgroup analysis revealed that male patients (Breslow p=0.001, Log-Rank p=0.001) and patients suffering with hypertension (Breslow p=0.003, Log-Rank p=0.001) were reasonable for these results whereas younger and older female patients showed similar short- and long-term outcome (Breslow p=0.926, Log-Rank p=0.724). After stratifying all patients into 4 age groups (<45; 55-65; 65-75; >75years), short-term survival of the patients appeared to be significantly poorer with increasing age (Breslow p=0.026, Log-Rank p=0.008) whereas long-term survival of patients free from cerebrovascular events (Breslow p=0.0494, Log-Rank p=0.489) remained similar.
All patients referred to our hospital for repair of Stanford A AAD with higher age had poorer short- and long-term survival, caused by male patients and patients suffering from hypertension, whereas survival of women and survival free from cerebrovascular events of the entire patient cohort was similar, irrespective of age.
斯坦福A型急性主动脉夹层（AAD）是一种危及生命的急症，通常发生于老年患者，需要立即进行手术修复。本研究旨在评估65岁及以上和65岁以下患者的早期结局以及短期和长期生存率。
2006年1月至2015年4月，240例斯坦福A型AAD患者在本中心接受了主动脉手术修复。经过统计分析和逻辑回归分析后，采用Kaplan-Meier生存估计法，对65岁及以上和65岁以下患者进行了长达9年的随访。
65岁及以上的斯坦福A型AAD患者比例为50%（n = 120）。65岁及以上患者组与65岁以下患者组相比，高血压（p = 0.012）、外周血管疾病（p = 0.026）和绝对快速性心律失常（p = 0.004）的优势比（OR）更高，差异有统计学意义。65岁以上患者的短期和长期生存率也明显较差。我们的亚组分析显示，男性患者（Breslow p = 0.001，Log-Rank p = 0.001）和高血压患者（Breslow p = 0.003，Log-Rank p = 0.001）符合这些结果，而年轻和老年女性患者的短期和长期结局相似（Breslow p = 0.926，Log-Rank p = 0.724）。将所有患者分为4个年龄组（<45岁；55 - 65岁；65 - 75岁；>75岁）后，患者的短期生存率似乎随着年龄的增加而显著降低（Breslow p = 0.026，Log-Rank p = 0.008），而无脑血管事件患者的长期生存率（Breslow p = 0.0494，Log-Rank p = 0.489）保持相似。
因男性患者和高血压患者，所有转诊至我院进行斯坦福A型AAD修复的老年患者的短期和长期生存率均较差，而整个患者队列中女性的生存率以及无脑血管事件的生存率相似，与年龄无关。
