Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Department of Cardiovascular Surgery, Texas Heart Institute, Houston, Tex.
Division of Cardiothoracic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex; Surgical Research Core, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Tex.
J Thorac Cardiovasc Surg. 2019 Oct;158(4):973-979. doi: 10.1016/j.jtcvs.2018.11.138. Epub 2018 Dec 19.
The data supporting performing elective aortic arch surgery in patients aged 75 years or older are equivocal. We evaluated short- and long-term outcomes after elective arch surgery in patients aged ≥75 years to determine whether complex arch operations are justified in such patients.
Over a 10-year period, 805 patients aged 50 to 89 years underwent elective proximal or total arch surgery. Composite adverse outcome was defined as operative mortality, persistent (ie, present at discharge) neurologic event, or persistent hemodialysis. Multivariable logistic regression was performed in the entire group.
Multivariable analysis showed that age at admission independently predicted composite adverse outcome, operative mortality, and prolonged (>48 hours) ventilator support (P < .0001 for all), but not stroke. The same results were shown in a subgroup analysis in which older age (80-89 years) was associated with composite adverse outcome, operative mortality, and prolonged ventilator support. In a Cox proportional hazards regression model adjusted for antegrade cerebral perfusion time and prior history of renal disease, patients aged 50 to 74 years had significantly better overall survival than patients aged ≥75 years (P < .001).
As endovascular technology evolves, having benchmark data from likely endovascular-therapy candidates is critical. This study, among the few to focus on elective aortic arch surgery in elderly patients, suggests that surgical intervention carries risk and that novel endovascular therapies are needed.
支持对 75 岁或以上患者进行择期主动脉弓手术的数据尚存在争议。我们评估了≥75 岁患者行择期弓部手术的短期和长期结果，以确定此类患者是否有必要进行复杂的弓部手术。
在 10 年期间，805 名年龄在 50 至 89 岁的患者接受了择期近端或全主动脉弓手术。复合不良结局定义为手术死亡率、持续性（即出院时存在）神经事件或持续性血液透析。对整个队列进行多变量逻辑回归分析。
多变量分析表明，入院时的年龄独立预测了复合不良结局、手术死亡率和延长（>48 小时）呼吸机支持（所有 P 值均<.0001），但不包括中风。在一个亚组分析中，结果相同，其中年龄较大（80-89 岁）与复合不良结局、手术死亡率和延长的呼吸机支持相关。在调整顺行性脑灌注时间和既往肾脏疾病史的 Cox 比例风险回归模型中，50 至 74 岁的患者总生存率明显优于≥75 岁的患者（P<.001）。
随着腔内技术的发展，拥有可能接受腔内治疗的患者的基准数据至关重要。这项研究是为数不多的专门针对老年患者择期主动脉弓手术的研究之一，表明手术干预存在风险，需要新的腔内治疗方法。
