Goebel Nora, Holder Simone A, Huether Franziska, Maw Eleanor, Ayala Rafael, Anguelov Yasemin, Franke Ulrich F W, Bail Dorothee
Department of Cardiovascular Surgery, Robert Bosch Hospital, 70376 Stuttgart, Germany.
Warwick Medical School, University of Warwick, Coventry CV4 7AL, UK.
J Clin Med. 2024 Sep 23;13(18):5645. doi: 10.3390/jcm13185645.
: Aortic dissection is still afflicted with significant morbidity and mortality. This research seeks to assess long-term outcomes and quality of life after emergency surgery for acute aortic dissection type A. : A total of 413 patients were analysed, who had been operated upon between 2000 and 2016 at our centre. We compared our results of the early (2000-2007) versus late (2008-2016) period with regards to 30-day and follow-up mortality and need for reoperation, including risk factor analysis. Quality of life was assessed via the SF-36 survey. : Calculated perioperative risk by EuroSCORE increased significantly from early, 24.9%, to late, 38.0%, < 0.001. Thirty-day rates of mortality decreased significantly from 26.7% to 17.4%, = 0.03. Survival at 1-, 5-, and 10-years was 92.3% vs. 91.8% ( = 0.91), 75.2% vs. 81.0% ( = 0.29), and 53.4% vs. 69.7% ( = 0.04). Freedom from reoperation was comparable between groups at follow-up: 74.0% vs. 85.7%, = 0.28. Quality of life was impaired. : Despite more complex severity of disease and operative procedures, the results of surgery for type A aortic dissection improved significantly over time at 30-day and 10-year follow-up. Quality of life was significantly impaired compared to a healthy reference population.
主动脉夹层仍然具有较高的发病率和死亡率。本研究旨在评估A型急性主动脉夹层急诊手术后的长期预后和生活质量。
共分析了413例患者,这些患者于2000年至2016年在我们中心接受了手术。我们比较了早期(2000 - 2007年)和晚期(2008 - 2016年)在30天和随访死亡率以及再次手术需求方面的结果,包括危险因素分析。通过SF - 36调查问卷评估生活质量。
欧洲心脏手术风险评估系统(EuroSCORE)计算的围手术期风险从早期的24.9%显著增加到晚期的38.0%,P < 0.001。30天死亡率从26.7%显著下降到17.4%,P = 0.03。1年、5年和10年生存率分别为92.3%对91.8%(P = 0.91),75.2%对81.0%(P = 0.29),以及53.4%对69.7%(P = 0.04)。随访时两组间再次手术的无发生率相当:74.0%对85.7%,P = 0.28。生活质量受损。
尽管疾病严重程度和手术操作更为复杂,但在30天和10年随访时,A型主动脉夹层手术的结果随时间显著改善。与健康对照人群相比,生活质量显著受损。