Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York; Department of Cardiovascular Surgery, Shonan-Kamakura General Hospital, Kamakura, Japan.
Division of Cardiothoracic and Vascular Surgery, New York Presbyterian Hospital, Columbia University Medical Center, New York, New York.
Ann Thorac Surg. 2020 Nov;110(5):1485-1493. doi: 10.1016/j.athoracsur.2020.02.063. Epub 2020 Apr 1.
Little is known about the chance of patients not experiencing complications (uneventful recovery) after aortic root replacement for aortic aneurysm. The aim of this study was to investigate the probability of uneventful recovery, identify its predictors, and address the association between the uneventful recovery and long-term survival.
Patients with aortic aneurysm who underwent elective aortic root replacement between 2005 and 2018 were retrospectively reviewed (N = 676). Uneventful recovery was defined as avoidance of all of the following complications during the index hospital stay (selected based on Cox proportional hazards regression for long-term survival): mortality, any stroke, reexploration for bleeding, respiratory failure, acute renal failure, deep sternal infection, and postcardiotomy shock. Permanent pacemaker implantation was included because of its clinical perspectives. Patients were divided into 4 different age groups (group <60 years of age, n = 299; group 60-69 years of age, n = 209; group 70-79 years of age, n = 125; group ≥80 years of age, n = 43), according to a restricted cubic spline analysis on in-hospital mortality and postoperative stroke.
Uneventful recovery was 78.1%. The probability of uneventful recovery decreased in a linear fashion as the age increases (82.6% in the group <60 years of age, 79.0% in the group 60-69 years of age, 70.4% in the group 70-79 years of age, 65.1% in the group ≥80 years of age; P = .007). A multivariable logistic regression showed age, left ventricular ejection fraction, previous cardiac surgery, and peripheral artery disease were independent predictors of uneventful recovery. Uneventful recovery resulted in significantly better 5-year survival (log-rank P = .039).
This study provides novel information regarding the probability of uneventful recovery while confirming low in-hospital mortality and stroke rates after elective aortic root replacement for aortic aneurysm. Importantly, uneventful recovery ensures excellent long-term survival.
对于主动脉瘤患者行主动脉根部置换术后无并发症（无意外恢复）的几率知之甚少。本研究旨在探讨无意外恢复的概率，确定其预测因素，并探讨无意外恢复与长期生存之间的关系。
回顾性分析 2005 年至 2018 年间接受择期主动脉根部置换术的主动脉瘤患者（N=676）。无意外恢复定义为避免索引住院期间发生以下所有并发症（根据长期生存的 Cox 比例风险回归选择）：死亡率、任何卒中、出血再探查、呼吸衰竭、急性肾衰竭、深部胸骨感染和心脏手术后休克。由于其临床意义，包括永久性起搏器植入。根据住院死亡率和术后卒中的限制立方样条分析，将患者分为 4 个不同年龄组（<60 岁组，n=299；60-69 岁组，n=209；70-79 岁组，n=125；≥80 岁组，n=43）。
无意外恢复为 78.1%。随着年龄的增长，无意外恢复的概率呈线性下降（<60 岁组为 82.6%，60-69 岁组为 79.0%，70-79 岁组为 70.4%，≥80 岁组为 65.1%；P=0.007）。多变量逻辑回归显示年龄、左心室射血分数、既往心脏手术和外周动脉疾病是无意外恢复的独立预测因素。无意外恢复显著提高了 5 年生存率（对数秩 P=0.039）。
本研究提供了关于择期主动脉根部置换术治疗主动脉瘤后无意外恢复概率的新信息，同时证实了低住院死亡率和卒中发生率。重要的是，无意外恢复可确保良好的长期生存。
