초록접수 현황
| 14F-154 | 구연 발표 |
Risk Factor Analysis in Patients Undergoing Thoracic Endovascular Aortic Repair: the Impact of Preoperative Maximal Aortic Diameter on Survival
노선균¹, 김준범², 정성호², 정철현², 이재원², 주석중²
¹ 한양대학교 의과대학 구리병원 흉부외과학교실
² 울산대학교 의과대학 서울아산병원 흉부외과학교실
Background : This study aims to evaluate the clinical outcomes of thoracic endovascular aortic repair (TEVAR) performed in a single tertiary center.
Methods : Total 95 adult patients (age 64.1±12.6 years, 73 males) who underwent TEVAR from January 2006 through December 2013 were enrolled in this study.
Results : Aneurysm (75.8%) accounts for the most common pathology necessitating TEVAR, followed by dissection (16.8%), transection (5.3%), and aorto-esophageal fistula (2.1%). Total arch debranching was performed in 28 patients (59.6%) and the maximal aortic diameter was 56.4±19.4 mm, preoperatively. The early major morbidity and 30-day mortality rates were 17.9% and 2.1%, respectively. On logistic regression analysis, total arch debranching procedure concomitant or prior to TEVAR was the only independent risk factor for early major morbidity (OR, 4.20; 95% CI, 1.33-13.27; P=0.014). During 20.7 months of median follow-up period, late major morbidity and all-cause mortality rates were 18.9% and 31.6%, respectively. Preoperative atrial fibrillation (HR, 23.5; 95% CI, 6.55-84.08; P<0.001), elevated serum creatinine (HR, 2.36; 95% CI, 1.09-5.10; P=0.029), and larger aortic diameter (HR, 1.04; 95% CI, 1.01-1.06; P=0.005) were revealed as independent risk factors for mortality on multivariate analysis. Assessing the predictive value of the maximal aortic diameter for mortality, the greatest accuracy was obtained at the cut-off value of 60 mm (area under curve, 0.74; 95% CI, 0.64-0.84; P<0.001), with 73.3% sensitivity and 66.2% specificity.
Conclusion : Scrupulous attention to reduce prevalence of early major morbidity following TEVAR may be necessary. Additionally, TEVAR should be judiciously implemented in patients whose aortic diameter exceeds 60 mm.
Methods : Total 95 adult patients (age 64.1±12.6 years, 73 males) who underwent TEVAR from January 2006 through December 2013 were enrolled in this study.
Results : Aneurysm (75.8%) accounts for the most common pathology necessitating TEVAR, followed by dissection (16.8%), transection (5.3%), and aorto-esophageal fistula (2.1%). Total arch debranching was performed in 28 patients (59.6%) and the maximal aortic diameter was 56.4±19.4 mm, preoperatively. The early major morbidity and 30-day mortality rates were 17.9% and 2.1%, respectively. On logistic regression analysis, total arch debranching procedure concomitant or prior to TEVAR was the only independent risk factor for early major morbidity (OR, 4.20; 95% CI, 1.33-13.27; P=0.014). During 20.7 months of median follow-up period, late major morbidity and all-cause mortality rates were 18.9% and 31.6%, respectively. Preoperative atrial fibrillation (HR, 23.5; 95% CI, 6.55-84.08; P<0.001), elevated serum creatinine (HR, 2.36; 95% CI, 1.09-5.10; P=0.029), and larger aortic diameter (HR, 1.04; 95% CI, 1.01-1.06; P=0.005) were revealed as independent risk factors for mortality on multivariate analysis. Assessing the predictive value of the maximal aortic diameter for mortality, the greatest accuracy was obtained at the cut-off value of 60 mm (area under curve, 0.74; 95% CI, 0.64-0.84; P<0.001), with 73.3% sensitivity and 66.2% specificity.
Conclusion : Scrupulous attention to reduce prevalence of early major morbidity following TEVAR may be necessary. Additionally, TEVAR should be judiciously implemented in patients whose aortic diameter exceeds 60 mm.
책임저자: 주석중
울산대학교 의과대학 서울아산병원 흉부외과학교실
연락처 : 노선균, Tel: 031-560-2300 , E-mail : skro@hyumc.com
