Chung Jennifer, Stevens Louis-Mathieu, Chu Michael W A, Dagenais Francois, Peterson Mark D, Boodhwani Munir, Bozinovski John, El-Hamamsy Ismail, Yamashita Michael H, Atoui Rony, Bittira Bindu, Payne Darrin, Ouzounian Maral
Division of Cardiac Surgery, University of Toronto, Toronto, Ontario, Canada.
Division of Cardiac Surgery, University of Montreal, Montreal, Ontario, Canada.
J Thorac Cardiovasc Surg. 2021 Sep;162(3):759-766.e1. doi: 10.1016/j.jtcvs.2020.02.032. Epub 2020 Feb 19.
Elderly patients are typically offered aortic surgery at similar diameter thresholds as younger patients, despite limited data quantifying their operative risk. We aim to report the incremental risk experienced by elderly patients undergoing aortic arch surgery.
In total, 2520 patients underwent aortic arch surgery between 2002 and 2018 in 10 centers. Patients were divided into 3 groups: <65 years (n = 1325), 65 to 74 years (n = 737), and ≥75 years (n = 458). Outcomes of interest were in-hospital mortality, stroke, and the modified Society of Thoracic Surgeons composite for mortality or major morbidity (STS-COMP). Multivariable modeling was performed to determine the association of age with these outcomes.
As age increased, there was an increasing rate of comorbidities, including diabetes (P < .001), renal failure (P < .001), and previous stroke (P = .01). Rates of acute aortic syndrome (P = .50) and total arch repair were similar (P = .59) between groups. Older patients had greater mortality (<65: 6.1% vs 65-74: 9.0% vs ≥75: 14%, P < .001), stroke (6.3% vs 7.7% vs 11%, P = .01) and STS-COMP (25% vs 32% vs 38%, P < .001). After multivariable risk-adjustment, a step-wise increase in complications was observed in the older age groups relative to the youngest in terms of in-hospital mortality (65-74: odds ratio [OR] 1.57, P = .04; ≥75: OR, 2.94, P = .001) and STS-COMP (65-74: OR, 1.57, P < .001; ≥75: OR, 1.96, P < .001).
Older patients experienced elevated rates of mortality and morbidity following aortic arch surgery. These results support a more measured approach when evaluating elderly patients. Further research is needed on age-dependent natural history of thoracic aneurysms and size thresholds for intervention.
尽管量化老年患者手术风险的数据有限，但通常为老年患者提供与年轻患者相似直径阈值的主动脉手术。我们旨在报告接受主动脉弓手术的老年患者所经历的额外风险。
2002年至2018年期间，共有2520例患者在10个中心接受了主动脉弓手术。患者分为3组：<65岁（n = 1325）、65至74岁（n = 737）和≥75岁（n = 458）。关注的结果包括住院死亡率、中风以及胸外科医师协会改良的死亡率或主要并发症综合指标（STS-COMP）。进行多变量建模以确定年龄与这些结果之间的关联。
随着年龄的增加，合并症发生率上升，包括糖尿病（P <.001）、肾衰竭（P <.001）和既往中风（P =.01）。各组间急性主动脉综合征发生率（P =.50）和全弓修复率相似（P =.59）。老年患者的死亡率更高（<65岁：6.1% vs 65 - 74岁：9.0% vs ≥75岁：14%，P <.001）、中风发生率更高（6.3% vs 7.7% vs 11%，P =.01）以及STS-COMP更高（25% vs 32% vs 38%，P <.001）。经过多变量风险调整后，相对于最年轻组，老年组在住院死亡率（65 - 74岁：比值比[OR]为1.57，P =.04；≥75岁：OR为2.94，P =.001）和STS-COMP方面的并发症呈逐步增加趋势（65 - 74岁：OR为1.57，P <.001；≥75岁：OR为1.96，P <.001）。
老年患者在主动脉弓手术后死亡率和发病率较高。这些结果支持在评估老年患者时采取更为审慎的方法。需要对胸主动脉瘤随年龄变化的自然病程和干预的大小阈值进行进一步研究。
