对老年患者上升大动脉动脉瘤进行手术与监测
Veronica F Chan1, Ming Hao Guo1, Thais Coutinho2
1Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, Ontario, Canada.
JTCVS open
|January 9, 2025
概括
患有大动脉根或上升大动脉动脉瘤 (ATAA) 的老年患者在监测和手术之间没有生存差异. 监测是选择的老年人具有ATAA<5.5厘米的可行选择.
科学领域:
- 心血管外科心血管外科
- 老年医学 老年医学
- 血管外科 血管外科
背景情况:
- 老年患者的大动脉根或上升大动脉动脉瘤 (ATAA) 管理仍在争论中,特别是关于5.0厘米的手术门.
- 在75岁及以上的患者中,ATAA的自然史和长期结果尚未得到充分证实.
研究的目的:
- 评估老年患者 (年龄≥75岁) 的ATAA自然史.
- 为了在这个人群中比较初始手术管理和ATAA初始监测之间的长期生存结果.
主要方法:
- 一组300名患有ATAA (≥40毫米) 的老年患者被分为初始手术 (n=58) 或初始监测 (n=242) 组.
- 全因死亡率是主要结果,使用卡普兰-梅尔曲线和多变量考克斯回归分析以确定死亡率预测因素.
主要成果:
- 在监测和手术组之间没有观察到8年生存时间的显著差异 (77.8%对71.8%,P=.65).
- 即使在初始动脉瘤直径≥5.0厘米的患者中,8年生存率在两组之间没有差异 (76.5%vs68.4%,P=.20).
- 更大的身体表面积 (HR 1.44) 和吸烟史 (HR 2.25) 是长期死亡率的独立预测因素.
结论:
- 在患有ATAA的老年患者中,初始监测和手术管理产生了类似的8年生存率.
- 在这个人群中存在高竞争性非动脉死亡风险.
- 对精心挑选的老年患者来说,监测可能是手术的合理替代方案,ATAA小于5.5厘米.
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