Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians
| Autor: | Yuuya Tauchi, Hikaru Matsuda, Hisashi Satoh, Kazuo Abe, Jumpei Yamamoto, Haruhiko Kondoh, Takashi Daimon |
|---|---|
| Rok vydání: | 2016 |
| Předmět: |
Male
Reoperation Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Population Kaplan-Meier Estimate 030204 cardiovascular system & hematology Blood Vessel Prosthesis Implantation 03 medical and health sciences Aortic aneurysm Postoperative Complications 0302 clinical medicine Aortic valve replacement Risk Factors Blood vessel prosthesis medicine.artery Ascending aorta Humans Medicine Hospital Mortality education Retrospective Studies Aged 80 and over Aortic dissection education.field_of_study business.industry Age Factors medicine.disease Mediastinitis Aortic Aneurysm Blood Vessel Prosthesis Surgery Aortic Dissection Treatment Outcome 030228 respiratory system Deep hypothermic circulatory arrest Female Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 152:439-446 |
| ISSN: | 0022-5223 |
| Popis: | Objective The number of older patients with acute aortic dissection type A (AAD [A]) is increasing as the population ages. We evaluated clinical outcomes for octogenarians with AAD (A) treated surgically at our hospital. Whenever possible, we limited the replacement site of the ascending aorta to the supracoronary and hemiarch. Methods Of 436 patients with AAD (A) seen in our hospital emergency room between April 2001 and August 2015, 90 were octogenarians. Surgery was performed using a simple cardiopulmonary bypass established through the right femoral artery and venous cannulation, and distal anastomosis was performed under deep hypothermic circulatory arrest at 20°C. Results Of the 90 octogenarians with AAD (A), 11 required cardiopulmonary resuscitation, 9 of whom died. Four patients with stable hemodynamics refused surgery. Thus, 77 were treated surgically. Of these 77 patients, isolated replacement of the ascending aorta or hemiarch was performed in 73 (94.8%), and total arch replacement in 4 (5.2%). Five patients (6.5%) died within 30 days, and 5 (6.5%) died in the hospital more than 30 days after surgery. Seven (9.1%) had a new stroke, 5 (6.5%) had pneumonia, and 4 (5.2%) had mediastinitis. Forty-four (57.1%) patients were discharged to their homes and 23 (30%) to rehabilitation hospitals. Three patients later required endovascular stent graft repair, which was successful in each case. The overall postoperative survival was 82%, 70%, and 62% at 1, 3, and 5 years, respectively. Conclusions Our results suggest that our limited replacement protocol for emergency AAD (A) surgery has early and midterm survival benefits for octogenarians. |
| Databáze: | OpenAIRE |
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