Bojko Markian M, Suhail Maham, Bavaria Joseph E, Bueker Alex, Hu Robert W, Harmon Joey, Habertheuer Andreas, Milewski Rita K, Szeto Wilson Y, Vallabhajosyula Prashanth
College of Medicine, Drexel University, Philadelphia, Pa.
Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
J Thorac Cardiovasc Surg. 2022 Jan;163(1):2-12.e7. doi: 10.1016/j.jtcvs.2020.03.157. Epub 2020 May 4.
The incidence of elderly patients with acute type A aortic dissection is increasing. A recent analysis of the International Registry of Acute Aortic Dissection failed to show a mortality benefit with surgery compared with medical management in octogenarians. Therefore, we compared our institutional outcomes of emergency surgery for acute type A aortic dissection in octogenarians versus septuagenarians to understand the outcomes of surgical intervention in elderly patients.
From 2002 to 2017, 70 octogenarians (aged ≥80 years) and 165 septuagenarians (70-79 years) underwent surgery for acute type A aortic dissection (N = 235, total). Quality of life was assessed by the RAND Short Form-36 quality of life survey. Midterm clinical and functional data were obtained retrospectively.
At baseline, septuagenarians had a higher prevalence of diabetes (20.6% vs 5.7%, P = .01). The prevalence of cardiopulmonary resuscitation was 4.8% versus 10.0% (P = .24) in septuagenarians and octogenarians. The prevalence of cardiogenic shock was 18.2% versus 27.1% (P = .17). Thirty-day/in-hospital mortality was 21.2% versus 28.6% (P = .29). Multivariable logistic regression identified cardiogenic shock as an independent risk factor for in-hospital mortality (odds ratio, 10.07; 95% confidence interval, 2.30-44.03) in octogenarians. Survival at 5 years was 49.7% (42.1%-58.6%) versus 34.2% (23.9%-48.8%) in septuagenarians and octogenarians, respectively. Responses to the quality of life survey were no different between septuagenarians and octogenarians across all 8 quality of life categories.
Clinical outcomes after surgery for acute type A aortic dissection are similar in octogenarians and septuagenarians. For discharged survivors, quality of life remains favorable and does not differ between the 2 groups.
老年急性A型主动脉夹层患者的发病率正在上升。最近一项对国际急性主动脉夹层注册研究的分析未能显示，与药物治疗相比，手术治疗对八旬老人有死亡率获益。因此，我们比较了我院八旬老人与七旬老人急性A型主动脉夹层急诊手术的结果，以了解老年患者手术干预的结果。
2002年至2017年，70名八旬老人（年龄≥80岁）和165名七旬老人（70 - 79岁）接受了急性A型主动脉夹层手术（共235例）。通过兰德36项简明健康调查评估生活质量。回顾性获取中期临床和功能数据。
基线时，七旬老人糖尿病患病率更高（20.6%对5.7%，P = 0.01）。七旬老人和八旬老人的心肺复苏患病率分别为4.8%和10.0%（P = 0.24）。心源性休克患病率分别为18.2%和27.1%（P = 0.17）。30天/住院死亡率分别为21.2%和28.6%（P = 0.29）。多变量逻辑回归确定心源性休克是八旬老人住院死亡率的独立危险因素（比值比，10.07；95%置信区间，2.30 - 44.03）。七旬老人和八旬老人5年生存率分别为49.7%（42.1% - 58.6%）和34.2%（23.9% - 48.8%）。在所有8个生活质量类别中，七旬老人和八旬老人对生活质量调查的回答没有差异。
八旬老人和七旬老人急性A型主动脉夹层手术后的临床结果相似。对于出院幸存者，生活质量仍然良好，两组之间没有差异。
