Fiore Antonio, Lega Javier Rodriguez, Buech Joscha, Mariscalco Giovanni, Perrotti Andrea, Wisniewski Konrad, Pinto Angel G, Demal Till, Rocek Jan, Kacer Petr, Gatti Giuseppe, Vendramin Igor, Rinaldi Mauro, Quintana Eduard, Perna Dario Di, Nappi Francesco, Field Mark, Harky Amer, Pettinari Matteo, Dell'Aquila Angelo M, Onorati Francesco, Jormalainen Mikko, Juvonen Tatu, Mäkikallio Timo, Radner Caroline, Peterss Sven, D'Andrea Vito, Biancari Fausto
Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain.
J Geriatr Cardiol. 2024 Nov 28;21(11):1015-1025. doi: 10.26599/1671-5411.2024.11.009.
To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.
Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.
326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients ( = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively ( < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%.
Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.
评估手术修复急性A型主动脉夹层（ATAAD）对八旬老人生存的益处。
本分析的对象是来自多中心欧洲A型主动脉夹层登记处（ERTAAD）接受急性ATAAD手术的患者。
326例（8.4%）患者年龄≥80岁。在280对倾向评分匹配的患者中，年龄≥80岁患者的住院死亡率为30.0%，年轻患者为20.0%（P = 0.006），而10年死亡率分别为93.2%和48.0%（P < 0.001）。八旬老人术后两年内的死亡风险较高，但在术后5年内与年轻患者相当。术后存活3个月的患者中，年龄<80岁患者的10年相对生存率为0.77，年龄≥80岁患者为0.46。八旬老人术后5年相对生存率明显下降。年龄≥85岁、肾小球滤过率、术前有创通气、术前肠系膜灌注不良和主动脉根部置换是八旬老人住院死亡率的独立预测因素（AUC = 0.792；E:O比 = 0.991；CITL = 0.016；斜率 = 1.096）。制定了一个累加评分。68.4%的患者风险评分为≤1，其住院死亡率为20.9%。
经过精心的患者选择，手术可能为年龄≥80岁的ATAAD患者带来生存益处，与年轻患者和普通人群相比，这种益处可能在术后持续长达5年。由于西方国家人口寿命的延长，这些发现具有重要的流行病学和临床意义。
