Aortic dissection type A versus type B: a different post-surgical death hazard?
| Autor: | D. Scalia, Dino Casarotto, Giulio Rizzoli, Enrico Tiso |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Pulmonary and Respiratory Medicine
Adult Male medicine.medical_specialty Aortic Rupture Aneurysm Age Distribution Postoperative Complications Risk Factors Cause of Death Prevalence Medicine Humans Poisson Distribution Sex Distribution Survival rate Cause of death Aged Proportional Hazards Models Aortic dissection business.industry Vascular disease Proportional hazards model Confounding General Medicine Perioperative Middle Aged medicine.disease Surgery Survival Rate Aortic Dissection Italy Female Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Zdroj: | European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery. 12(2) |
| ISSN: | 1010-7940 |
| Popis: | Objective: Patients with type B aortic dissection differ from patients with type A dissection in age, hypertension prevalence, indications and timing of surgical treatment, yet reported long-term results have been rather similar (see Doroghazi et al. J Am Coll Cardiol 1984;3:1026‐1034). Methods: With the aim of comparing the post-surgical history, we have reviewed our results in 288 dissections, 213 type A and 75 type B, operated consecutively between 1 January 1970 and 31 November 1994. Follow-up was 100% complete. Empirical survival of both groups was interpolated with a fully parametric method and the shape and scale of the hazard function was investigated. Results: Survival was not significantly different between type A and type B. Parametric survival was, respectively, 0.52% (70% C.L.: 0.48‐0.55) vs. 0.56% (0.51‐0.62) at 5 years, 0.44% (0.40‐0.47) vs. 0.28% (0.23‐0.25) at 10 years, 0.37% (0.33‐0.41) vs. 0.25% (0.19‐0.32) at 15 years, and 0.31% (0.26‐0.35) vs. 0.24% (0.18‐0.31) at 20 years. Following the high perioperative risk phase in type A dissection, the intermediate and late risk remains constant at a rate of 0.0033 events:month (3.9% patient-years (pt.-years)). By contrast, the postoperative course of type B dissection shows an intermediate risk phase between 4 and 10 years with an average linearized risk of 9.3% pt.-years and a peak of 20%. This determined lower survival rates (24 vs. 31% at 20 years, PNS). Conclusions: We conclude that patients with type B dissection have a steeper postoperative death hazard as compared to type A dissection patients. Age confounding or late entry do not explain the difference. This could be possibly related to a greater propensity for expansion, higher risk of malperfusion complications or to limitations of our current surgical treatment. © 1997 Elsevier Science B.V. |
| Databáze: | OpenAIRE |
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