Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Department of Cardiothoracic Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands.
Semin Thorac Cardiovasc Surg. 2019;31(4):638-642. doi: 10.1053/j.semtcvs.2019.05.032. Epub 2019 Jun 14.
Treatment decision-making in thoracic aortic aneurysms of the ascending aorta is complex both with regard to the timing of surgery and with regard to the invasive treatment strategy. From a clinician perspective, it is seen as important to balance the risks of watchful waiting versus preventive surgery and to choose a surgical treatment strategy that will result in the lowest early and late event occurrence. The current clinical practice guidelines and reported outcomes after surgery suggest that there are many gray zones in determining the optimal timing and the type of intervention. From a patient perspective, quality of life and in particular minimization of anxiety and depression due to the fear of aortic rupture or the potential occurrence of complications related to the different treatment strategies are important to consider. Quality of life studies and evidence on the importance of patient participation in decision-making make a strong case for evidence-based shared treatment decision in this complex patient group.
胸主动脉瘤升主动脉的治疗决策既涉及手术时机，也涉及有创治疗策略，非常复杂。从临床医生的角度来看，权衡密切观察与预防性手术的风险，选择一种将导致最低早期和晚期事件发生率的手术治疗策略是很重要的。目前的临床实践指南和手术后的报告结果表明，在确定最佳时机和干预类型方面存在许多灰色地带。从患者的角度来看，生活质量，特别是减轻因担心主动脉破裂或不同治疗策略相关并发症而产生的焦虑和抑郁，是需要考虑的重要因素。生活质量研究和关于患者参与决策重要性的证据强烈支持在这一复杂患者群体中进行基于证据的共同治疗决策。
