What is the appropriate size criterion for resection of thoracic aortic aneurysms?
| Autor: | John A. Rizzo, Divakar Mandapati, Gary S. Kopf, John A. Elefteriades, Umer Darr, Michael A. Coady, Graeme L. Hammond |
|---|---|
| Rok vydání: | 1997 |
| Předmět: |
Adult
Male Pulmonary and Respiratory Medicine medicine.medical_specialty Adolescent Aortic Rupture Dissection (medical) Aortic aneurysm Aneurysm Risk Factors medicine.artery medicine Humans Thoracic aorta Survival rate Aged Aged 80 and over Aortic dissection Aortic Aneurysm Thoracic business.industry Patient Selection Middle Aged Prognosis medicine.disease Surgery Survival Rate Aortic Dissection Logistic Models Cardiothoracic surgery Descending aorta cardiovascular system Female Radiology Cardiology and Cardiovascular Medicine business |
| Zdroj: | The Journal of Thoracic and Cardiovascular Surgery. 113:476-491 |
| ISSN: | 0022-5223 |
| Popis: | Although many articles have described techniques for resection of thoracic aortic aneurysms, limited information on the natural history of this disorder is available to aid in defining criteria for surgical intervention. Data on 230 patients with thoracic aortic aneurysms treated at Yale University School of Medicine from 1985 to 1996 were analyzed. This computerized database included 714 imaging studies (magnetic resonance imaging, computed tomography, echocardiography). Mean size of the thoracic aorta in these patients at initial presentation was 5.2 cm (range 3.5 to 10 cm). The mean growth rate was 0.12 cm/yr. Overall survivals at 1 and 5 years were 85% and 64%, respectively. Patients having aortic dissection had lower survival (83% 1 year; 46% 5 year) than the cohort without dissection (89% 1 year; 71% 5 year). One hundred thirty-six patients underwent surgery for their thoracic aortic aneurysms. For elective operations, the mortality was 9.0%; for emergency operations, 21.7%. Median size at time of rupture or dissection was 6.0 cm for ascending aneurysms and 7.2 cm for descending aneurysms. The incidence of dissection or rupture increased with aneurysm size. Multivariable regression analysis to isolate risk factors for acute dissection or rupture revealed that size larger than 6.0 cm increased the probability by 32.1 percentage points for ascending aneurysms (p = 0.005). For descending aneurysms, this probability increased by 43.0 percentage points at a size greater than 7.0 cm (p = 0.006). If the median size at the time of dissection or rupture were used as the intervention criterion, half of the patients would suffer a devastating complication before the operation. Accordingly, a criterion lower than the median is appropriate. We recommend 5.5 cm as an acceptable size for elective resection of ascending aortic aneurysms, because resection can be performed with relatively low mortality. For aneurysms of the descending aorta, in which perioperative complications are greater and the median size at the time of complication is larger, we recommend intervention at 6.5 cm. (J Thorac Cardiovasc Surg 1997;113:476-91) |
| Databáze: | OpenAIRE |
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