在急性A型大动脉剖析手术后的生存率在八岁以上的人群中
Antonio Fiore1, Javier Rodriguez Lega2, Joscha Buech3,4
1Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
Journal of geriatric cardiology : JGC
|December 30, 2024
概括
急性A型大动脉解剖 (ATAAD) 的手术修复可能有利于八十岁的患者,在手术后长达五年的生存优势. 仔细选择患者对于优化这一老年人群的治疗结果至关重要.
科学领域:
- 心血管外科心血管外科
- 胸部外科手术 胸部外科手术
- 大动脉剖析研究研究
背景情况:
- 急性甲动脉解剖A型 (ATAAD) 是一种危及生命的疾病,需要紧急干预.
- 八代人 (≥80岁) 代表着面临ATAAD的日益增长的患者人口统计,在历史上外科手术结果较差.
- 鉴于人口老龄化,评估80岁以上人群手术修复ATAAD的特定生存益处和风险至关重要.
研究的目的:
- 评估急性A型大动脉解剖 (ATAAD) 的手术修复对八十岁患者的生存益处.
- 为了比较接受ATAAD手术的80岁以上患者的结果与年轻患者的结果.
- 确定八十多岁的ATAAD患者住院死亡率的预测因素.
主要方法:
- 来自欧洲A型大动脉剖析注册表 (ERTAAD) 的急性ATAAD手术患者的分析.
- 倾向性得分匹配用于比较326名八十岁以上 (≥80岁) 患者与年轻患者.
- 统计分析包括住院死亡率,10年死亡率,相对存活率和死亡率的独立预测因素的识别.
主要成果:
- 与年轻患者 (20.0%) 相比,80岁以上的患者 (30.0%) 的住院死亡率更高 (P = 0.006).
- 八十岁患者的10年死亡率明显高 (93.2%) 与年轻患者 (48.0%) (P < 0.001) 相比.
- 八十多岁患者的死亡风险在手术后的5年内与年轻患者相比较;然而,5年后相对存活率明显下降. 住院死亡率的预测因素包括年龄≥85岁,功能,通风,介肠透和大动脉根置换. 开发了一个风险得分,得分≤1与20.9%的住院死亡率相关.
结论:
- ATAAD的手术修复可能为精心挑选的八十岁患者提供生存益处,可能持续长达五年.
- 这些发现强调了患者选择在老年人群中进行手术修复ATAAD的重要性.
- 鉴于预期寿命的增加,这些结果对老年人治疗ATAAD具有重要的临床和流行病学意义.
相关概念视频
Aortic Regurgitation I: Introduction
1.6K
IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
1.6K
Aortic Regurgitation III: Medical Management
598
Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
598
Peripheral Artery Disease V: Postoperative Nursing Management
637
During the postoperative period, it is crucial to focus on maintaining circulation, identifying and managing potential complications, and planning for discharge.Nursing AssessmentVital signs monitoring: Regularly monitor vital signs, including blood pressure, heart rate, respiratory rate, and temperature, to detect early signs of complications such as bleeding and infection.Circulation assessment: Monitor pulses, perform Doppler assessments, and check capillary refill, color, temperature, and...
637
Aneurysm II: Clinical Manifestations and Diagnostic Studies
592
Thoracic, aortic arch and abdominal aneurysms are significant vascular conditions that can present with various clinical manifestations and lead to serious complications. Understanding these manifestations and the appropriate diagnostic studies is essential for effective management and treatment.Thoracic Aortic AneurysmsThoracic aortic aneurysms often remain asymptomatic until they reach a size that impinges on adjacent structures. They typically cause deep, diffuse chest pain that radiates to...
592
Aneurysm III: Interprofessional Care
478
Aneurysm management involves either conservative medical therapy or surgical intervention, depending on the size and symptoms of the aneurysm. Conservative management is generally reserved for smaller, asymptomatic aneurysms, while larger or symptomatic aneurysms often necessitate surgical repair.Conservative Medical TherapyFor small, asymptomatic aneurysms, particularly abdominal aortic aneurysms (AAA) less than 5.5 centimeters in diameter, conservative medical therapy is recommended. This...
478
Aneurysm IV: Nursing Management
625
Vigilant monitoring for aneurysm rupture is essential for patients undergoing aortic surgery.Preoperative Nursing ManagementContinuously monitor the patient for manifestations of aneurysm rupture, such as pallor, weakness, tachycardia, hypotension, abdominal, back, groin, or periumbilical pain, changes in consciousness, and a pulsating abdominal mass. Regularly assess the patient's peripheral pulses.Instruct the patient to consume a clear liquid diet the day before surgery and administer...
625


