초록접수 현황
| 14F-131 | 구연 발표 |
A Single Institution 15 Year Risk Factor Analysis of Acute Type a Aortic Dissection; Does Old Age Pose a Prohibitive Surgical Risk?
김윤석¹, 노선균², 김지훈¹, 이석인¹, 이성준¹, 정성호¹, 주석중¹, 정철현¹, 이재원¹
울산대학교 의과대학 서울아산병원 흉부외과학교실¹, 한양대학교 의과대학 한양대학교 구리병원 흉부외과학교실²
Background : To review our experience with acute type A aortic dissection repair and to assess the impact of old age on the outcomes.
Methods : From January 1999 to December 2013, a total of 270 patients (mean age, 56.9 ± 13.0; 137 females) underwent surgery for acute type A aortic dissection. Of these patients, 41 comprised elderly patients (age > 70 years).
Results : Of the 270 patients, 208 (77.0%) underwent ascending aorta and hemiarch replacement and 62 (23.0%) underwent ascending aorta and total arch replacement. There were 22 (8.1%) cases of new permanent strokes and 26 (9.6%) operative deaths. Hemodynamic instability (OR = 4.53; 95% CI = 1.48 - 13.88; p = 0.008) and cardiopulmonary bypass time (OR = 1.006; 95% CI = 1.002 - 1.010; p = 0.002) were identified as independent predictors of operative mortality on multivariate analysis. Freedom from re-intervention at 5 years was 83.9 ± 3.4% (median follow-up period of 41.5, interquartile range of 15.2 – 63.7 months). Old age (> 70 years) was not a significant independent factor for increased risk of new permanent stroke (OR = 0.54; 95% CI = 0.12 – 2.39; p = 0.41) or operative mortality (OR = 2.28; 95% CI = 0.89 – 5.82, p = 0.086).
Conclusion : The overall morbidity and mortality risks for acute type A aortic dissection were acceptable and advanced age was not a significant negative risk factor for surgery. Therefore, in the absence of life limiting conditions, surgery should be actively performed in elderly patients.
Methods : From January 1999 to December 2013, a total of 270 patients (mean age, 56.9 ± 13.0; 137 females) underwent surgery for acute type A aortic dissection. Of these patients, 41 comprised elderly patients (age > 70 years).
Results : Of the 270 patients, 208 (77.0%) underwent ascending aorta and hemiarch replacement and 62 (23.0%) underwent ascending aorta and total arch replacement. There were 22 (8.1%) cases of new permanent strokes and 26 (9.6%) operative deaths. Hemodynamic instability (OR = 4.53; 95% CI = 1.48 - 13.88; p = 0.008) and cardiopulmonary bypass time (OR = 1.006; 95% CI = 1.002 - 1.010; p = 0.002) were identified as independent predictors of operative mortality on multivariate analysis. Freedom from re-intervention at 5 years was 83.9 ± 3.4% (median follow-up period of 41.5, interquartile range of 15.2 – 63.7 months). Old age (> 70 years) was not a significant independent factor for increased risk of new permanent stroke (OR = 0.54; 95% CI = 0.12 – 2.39; p = 0.41) or operative mortality (OR = 2.28; 95% CI = 0.89 – 5.82, p = 0.086).
Conclusion : The overall morbidity and mortality risks for acute type A aortic dissection were acceptable and advanced age was not a significant negative risk factor for surgery. Therefore, in the absence of life limiting conditions, surgery should be actively performed in elderly patients.
책임저자: 주석중
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 김윤석, Tel: 02-3010-3580 , E-mail : yunseok99@hanmail.net
