초록접수 현황
| 15F-191 | 구연 발표 |
Early and Late Surgical Outcomes after Total Arch Replacement: AMC Experience
김호진, 주석중, 정성호, 정철현, 이재원
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
Background : We aim to analyze the 20-year experience with total arch replacement performed at our institution.
Methods : A retrospective chart review was performed on all patients undergoing total arch replacement at the Asan Medical Center from January 1996 to June 2015. The entire cohort was divided into the two groups based on the year of surgery: Era 1 (1996-2007) and Era 2 (2008-2015). Early and late surgical outcomes were compared and analyzed between the two groups.
Results : A total of 217 patients (aged 58.1±15.1 years, 133 males) were operated during the study period (74 patients in Era 1 and 143 patients in Era 2). There has been an increase in total arch replacement for degenerative aneurysm (Era 1 vs. Era 2, 19 (25.7%) vs. 65 (45.5%); P=0.007) and a relative decrease for acute aortic dissection (Era 1 vs. Era 2, 43 (58.1%) vs. 52 (36.4%); P=0.004). Early death occurred in 26 patients (12.0%), and a total of 64 patients (29.5%) died during follow-up. Over time, a strong tendency was observed for a decrease in the early mortality with emergency operation (Era 1 vs. Era 2, 9 (19.1%) vs. 6 (9.4%); P=0.227), but in elective operation, there was a tendency for early mortality to increase (Era 1 vs. Era 2, 1 (3.7%) vs. 10 (12.7%); P=0.341). There was no significant difference in early morbidities between the two groups: low cardiac output syndrome (P=0.414), stroke (P>0.99), bleeding (P=0.874), and sternal wound problem (P=0.627). On Kaplan-Meier analysis, there was no significant difference in the long-term survival between the two groups (log rank P=0.224).
Conclusion : Our study demonstrated that total arch replacement can be performed with acceptable mortality and morbidities. An increased tendency for early mortality with elective operation may reflect the high comorbid factors inherent in the degenerative arch disease patients.
Methods : A retrospective chart review was performed on all patients undergoing total arch replacement at the Asan Medical Center from January 1996 to June 2015. The entire cohort was divided into the two groups based on the year of surgery: Era 1 (1996-2007) and Era 2 (2008-2015). Early and late surgical outcomes were compared and analyzed between the two groups.
Results : A total of 217 patients (aged 58.1±15.1 years, 133 males) were operated during the study period (74 patients in Era 1 and 143 patients in Era 2). There has been an increase in total arch replacement for degenerative aneurysm (Era 1 vs. Era 2, 19 (25.7%) vs. 65 (45.5%); P=0.007) and a relative decrease for acute aortic dissection (Era 1 vs. Era 2, 43 (58.1%) vs. 52 (36.4%); P=0.004). Early death occurred in 26 patients (12.0%), and a total of 64 patients (29.5%) died during follow-up. Over time, a strong tendency was observed for a decrease in the early mortality with emergency operation (Era 1 vs. Era 2, 9 (19.1%) vs. 6 (9.4%); P=0.227), but in elective operation, there was a tendency for early mortality to increase (Era 1 vs. Era 2, 1 (3.7%) vs. 10 (12.7%); P=0.341). There was no significant difference in early morbidities between the two groups: low cardiac output syndrome (P=0.414), stroke (P>0.99), bleeding (P=0.874), and sternal wound problem (P=0.627). On Kaplan-Meier analysis, there was no significant difference in the long-term survival between the two groups (log rank P=0.224).
Conclusion : Our study demonstrated that total arch replacement can be performed with acceptable mortality and morbidities. An increased tendency for early mortality with elective operation may reflect the high comorbid factors inherent in the degenerative arch disease patients.
책임저자: 주석중
Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
연락처 : 주석중, Tel: 01043480927 , E-mail : sjchoo@amc.seoul.kr
