| Autor: |
Ehrlich, Marek P., Grabenwöger, Martin, Kilo, Juliane, Kocher, Alfred A., Grubhofer, Georg, Lassnig, Andrea M., Tschernko, Edda M., Schlechta, Bernhard, Hutschala, Doris, Domanovits, Hans, Sodeck, Gottfried, Wolner, Ernst |
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| Zdroj: |
Annals of Thoracic Surgery; Jun2002, Vol. 73 Issue 6, p1843, 6p |
| Abstrakt: |
Background. The purpose of this study was to evaluate the significance of aortic rupture on clinical outcome in patients after aortic repair for acute type A dissection.Methods. One hundred and twenty patients underwent aortic operations with resection of the intimal tear and open distal anastomosis. Median age was 60 years (range 16 to 87); 78 were male. Thirty-six patients had only ascending aortic replacement, 82 had hemiarch repair, and 2 had the entire arch replaced. Retrograde cerebral perfusion was utilized in 66 patients (53%). Rupture defined as free blood in the pericardial space was present in 60 patients (50%). Univariate and multivariate analyses were performed to assess the risk factors for mortality and neurologic dysfunction.Results. Overall hospital mortality rate was 24.2% ± 4.0% (± 70% confidence level) but did not differ between patients with aortic rupture or without (p = 0.83). The incidence of permanent neurologic dysfunction was 9.4% overall, 10.5% with rupture and 8.3% without rupture (p = 0.75). Multivariate analysis revealed absence of retrograde cerebral perfusion and any postoperative complication as statistically significant indicators for in-hospital mortality (p < 0.05). Overall 1- and 5-year survival was 85.3% and 33.7%; among discharged patients, survival in the nonruptured group was 89% and 37%, versus 81% and 31% in the ruptured group (p = 0.01).Conclusions. Aortic rupture at the time of surgery does not increase the risk of hospital mortality or permanent neurologic complications in patients with acute type A dissections. However, aortic rupture at the time of surgery does influence long-term survival. [Copyright &y& Elsevier] |
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