Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité (DHZC), Berlin, Germany.
Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Eur J Cardiothorac Surg. 2023 Oct 4;64(4). doi: 10.1093/ejcts/ezad288.
The aim of this study is to investigate the outcome of elderly patients with surgically treated acute type A aortic dissection (ATAAD) complicated by malperfusion.
Patients ≥70 years old who underwent surgical treatment for ATAAD between January 2000 and December 2020 were enrolled in this study and stratified by their specific Penn Classification into 4 different subgroups, where Penn Abc was defined as multilevel malperfusion. Short- and long-term outcomes were investigated. Multivariable binary logistic regression was performed to identify risk factors for 1-year mortality.
Four hundred elderly patients underwent surgical treatment for ATAAD. A total of 204 (51%) patients had no evidence of malperfusion (Penn Aa), 106 (26.5%) had localized organic malperfusion (Penn Ab), 44 (11%) patients had systemic malperfusion (Penn Ac) and 46 (11.5%) suffered from multilevel malperfusion (Penn Abc). For the latter, in-hospital mortality was 70% (P < 0.001). Age (P < 0.006) and multilevel malperfusion (P < 0.001) were independent risk factors for 1-year mortality. Patients with multilevel malperfusion showed the worst 1-year survival (P < 0.001). In the case of Penn Aa, in-hospital mortality was 13% (P < 0.001).
Surgery may lead to satisfactory results in the absence of malperfusion, even in octogenarians. Elderly patients with multilevel malperfusion show very poor surgical outcome. In these patients, the decision for surgery should be taken with caution. Operation, if performed, should be carried out by experienced teams only.
本研究旨在探讨伴有灌注不良的老年急性 A 型主动脉夹层（ATAAD）患者的治疗结果。
本研究纳入了 2000 年 1 月至 2020 年 12 月期间接受手术治疗的年龄≥70 岁的 ATAAD 患者，并根据他们的具体 Penn 分类分为 4 个不同亚组，其中 Penn Abc 定义为多水平灌注不良。研究调查了短期和长期结果。采用多变量二项逻辑回归分析确定 1 年死亡率的危险因素。
共有 400 名老年患者接受了 ATAAD 的手术治疗。共有 204 名（51%）患者无灌注不良证据（Penn Aa），106 名（26.5%）患者有局部有机灌注不良（Penn Ab），44 名（11%）患者有全身灌注不良（Penn Ac），46 名（11.5%）患者有多个水平灌注不良（Penn Abc）。对于后者，住院死亡率为 70%（P<0.001）。年龄（P<0.006）和多水平灌注不良（P<0.001）是 1 年死亡率的独立危险因素。多水平灌注不良的患者 1 年生存率最差（P<0.001）。在 Penn Aa 的情况下，住院死亡率为 13%（P<0.001）。
在无灌注不良的情况下，手术可能会带来令人满意的结果，即使是在 80 岁以上的患者中。多水平灌注不良的老年患者手术效果非常差。在这些患者中，应谨慎决定手术。如果进行手术，应由经验丰富的团队进行。
