Survival after surgery for acute type A aortic dissection in octogenariansOA
Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods 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.Results 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(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<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%.Conclusions 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.
Antonio Fiore;Javier Rodriguez Lega;Joscha Buech;Giovanni Mariscalco;Andrea Perrotti;Konrad Wisniewski;Angel G.Pinto;Till Demal;Jan Rocek;Petr Kacer;Giuseppe Gatti;Igor Vendramin;Mauro Rinaldi;Eduard Quintana;Dario Di Perna;Francesco Nappi;Mark Field;Amer Harky;Matteo Pettinari;Angelo M.Dell’Aquila;Francesco Onorati;Mikko Jormalainen;Tatu Juvonen;Timo Mäkikallio;Caroline Radner;Sven Peterss;Vito D’Andrea;Fausto Biancari
Department of Cardiac Surgery,Hôpitaux Universitaires Henri Mondor,Creteil,FranceCardiovascular Surgery Department,University Hospital Gregorio Marañón,Madrid,SpainLMU University Hospital,Ludwig Maximilian University,Munich,Germany German Centre for Cardiovascular Research,Partner Site Munich Heart Alliance,Munich,GermanyDepartment of Cardiac Surgery,Glenfield Hospital,Leicester,United KingdomDepartment of Thoracic and Cardiovascular Surgery,University of Franche-Comte,Besancon,FranceDepartment of Cardiothoracic Surgery,University Hospital Muenster,Muenster,GermanyCardiovascular Surgery Department,University Hospital Gregorio Marañón,Madrid,SpainDepartment of Cardiovascular Surgery,University Heart and Vascular Center Hamburg,Hamburg,GermanyDepartment of Cardiac Surgery,Charles University and University Hospital Kralovske Vinohrady,Prague,Czech RepublicDepartment of Cardiac Surgery,Charles University and University Hospital Kralovske Vinohrady,Prague,Czech RepublicDivision of Cardiac Surgery,Cardio-thoracic and Vascular Department,Azienda Sanitaria Universitaria Giuliano Isontina,Trieste,ItalyCardiothoracic Department,University Hospital,Udine,ItalyCardiac Surgery,Molinette Hospital,University of Turin,Turin,ItalyDepartment of Cardiovascular Surgery,Hospital Clínic de Barcelona,University of Barcelona,Barcelona,SpainDepartment of Cardiac Surgery,Centre Hospitalier Annecy Genevois,Epagny Metz-Tessy,FranceDepartment of Cardiac Surgery,Centre Cardiologique du Nord de Saint-Denis,Paris,FranceLiverpool Centre for Cardiovascular Sciences,Liverpool Heart and Chest Hospital,Liverpool,United KingdomLiverpool Centre for Cardiovascular Sciences,Liverpool Heart and Chest Hospital,Liverpool,United KingdomDepartment of Cardiac Surgery,Ziekenhuis Oost Limburg,Genk,Belgium,and Département Cardiovasculair,Cliniques Universitaries Saint Luc,Bruxelles,BelgiumDepartment of Cardiac surgery,Martin Luther University Halle-Wittenberg,Halle,GermanyDivision of Cardiac Surgery,University of Verona Medical School,Verona,ItalyFaculty of Medicine,University of Oulu,Oulu,FinlandFaculty of Medicine,University of Oulu,Oulu,Finland Heart and Lung Center,Helsinki University Central Hospital,University of Helsinki,Helsinki,FinlandDepartment of Medicine,South-Karelia Central Hospital,University of Helsinki,Lappeenranta,FinlandLMU University Hospital,Ludwig Maximilian University,Munich,Germany German Centre for Cardiovascular Research,Partner Site Munich Heart Alliance,Munich,GermanyLMU University Hospital,Ludwig Maximilian University,Munich,GermanyDepartment of Surgical Sciences,Sapienza University of Rome,Rome,ItalyDepartment of Cardiovascular Surgery,Centro Cardiologico Monzino IRCCS,Milan,Italy
临床医学
surgerydissectionSurvival
《Journal of Geriatric Cardiology》 2024 (11)
P.1015-1025,11
supported by the Finnish Heart Associationby the Sigrid Jusélius Foundation.
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