EARLY AND LATE SURVIVAL OF REPAIRED TYPE-A AORTIC DISSECTION

被引：16

作者：

RIZZOLI, G

MAZZUCCO, A

FRACASSO, A

GIAMBUZZI, M

RUBINO, M

GALLUCCI, V

机构：

[1] Department of Cardiovascular Surgery, University of Padua, Padua

来源：

EUROPEAN JOURNAL OF CARDIO-THORACIC SURGERY | 1990年 / 4卷 / 11期

关键词：

Aortic dissection type A; Risk factors;

D O I：

10.1016/1010-7940(90)90015-R

中图分类号：

R5 [内科学];

学科分类号：

1002 ; 100201 ;

摘要：

From 1 January 1977 to 31 December 1988, 119 patients were operated upon for type A aortic dissection. The maximum follow-up was 11.7 years (median 5.6 years); follow-up was 100% complete. Actuarial survival was 47.3% ± 5%. The death risk decreased rapidly to a constant rate of 0.0027 events/month after 3 months. There were 41 early deaths, mostly due to haemorrhage, brain damage and low output syndrome. A significantly higher probability of early death was observed in patients with preoperative myocardial ischaemia or infarction (P < 0.0001) or preoperative cerebral symptoms (P = 0.0002). Extended dissection increased the risk proportionally to the length of the aorta involved (P = 0.0002). Typical dissection originating from an intimal tear in the ascending aorta had a significantly lower operative risk than a typical dissection with an intimal tear not localized in the aortic root (P = 0.0006). Of the 14 late deaths, 2 were unrelated to dissection, 2 were of unknown origin and 4 were sudden. Stroke was the cause of 2 and congestive heart failure the cause of 4 deaths. The probability of late death was higher in patients with perioperative brain damage (P = 0.003) and in patients with preoperative shock (P = 0.0025). It was significantly lower in patients with dissection of hypertensive aetiology (P = 0.002). There were 13 reoperations on 12 patients. Early reoperations [3] were due to rupture of the distal aortic anastomosis. Late reoperations were mostly due to dehiscence of aortic valvular prosthesis. In 6 cases, the cause was an enlarging aneurysm or pseudo-aneurysm of the aorta or a new dissection. Reoperation-free survival was 42%. In patients with a typical dissection of hypertensive aetiology and limited extension (0–3 aortic segments), the expected survival was 80% or higher and identical to that of the matched normal population. The significance and strength of each risk factor is discussed as well as methods for their neutralization so as to offer effective palliation of this deadly disease. © Springer-Verlag.

引用

页码：575 / 583

页数：9

共 28 条

[1]

Anagnastopulos C.E., Prabhakar M.J.S., Kittle C.F., Aortic dissections and dissecting aneurysm, Am J Cardiol, 30, pp. 263-268, (1972)

[2]

Bachet J., Teodori G., Goudot B., Diaz F., El Kerdany A., Dubois C., Brodaty D., De Lentdecker P., Guilmet D., Replacement of the transverse aortic arch during emergency operation for type A acute aortic dissection, J Thorac Cardiovasc Surg, 96, pp. 878-886, (1988)

[3]

Blackstone E.H., Naftel D.C., Turner M., The decomposition of time-varying hazard into phase, each incorporating a separate stream of concomitant information, J Am Stat Assoc, 81, pp. 615-624, (1986)

[4]

Cachera J.P., Vouche P.R., Loisance D.J., Menu P., Poulain H., Bloch G., Vasile N., Aubry G., Galey J.J., Surgical management of acute dissections involving the ascending aorta: early and late results in 38 patients, J Thorac Cardiovasc Surg, 28, pp. 576-584, (1981)

[5]

Cohn L.H., J Thorac Cardiovasc Surg, 78, pp. 365-382, (1979)

[6]

DeBakey M.E., McCallum C.H., Crawford E.S., Morris G.C., Howell J., Noon G.P., Lawrie G., Dissection and dissecting aneurysms of the aorta: twenty-year follow-up of five hundred twenty-seven patients treated surgically, Surgery, 92, pp. 1118-1134, (1982)

[7]

Dorogazy R.M., Slater E.E., DeSanctis R.W., Buckley M.J., Austen W.G., Rosenthal S., Long term survival of patients with treated aortic dissection, J Am coll Cardiol, 3, pp. 1026-1034, (1948)

[8]

Dureau G., Willard J., George M., Clermont A., Pinet F., Estanove S., Marion P., Persistence du faux chenal apre rempacement prothetique de 1'aorte ascendante pour dissection aigue de type 1, Ann Chir Thorac Cardiovasc, 30, pp. 123-127, (1976)

[9]

Gallucci V., Valfre C., Caruso G., Panizzon G., Aru G., Mazzucco A., Cevese P.G., Dissecting aortic aneurysm: Ten year experience and long term results of surgical treatment, pp. 466-472, (1981)

[10]

Graham J.M., Stinnet M., Operative management of acute aortic arch dissection using profound hypothermia and circulatory arrest, Ann Thorac Surg, 44, pp. 192-198, (1987)

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