Surgical Results and Quality of Life in Stanford Type A Aortic Dissection.
10.4326/jjcvs.26.230
- VernacularTitle:Ｓｔａｎｆｏｒｄ Ａ型大動脈解離のＱＯＬを含めた手術成績
- Author:
Tomoe Katoh
;
Kensuke Esato
;
Yoshihiko Fujimura
;
Hidenori Gohra
;
Kimikazu Hamano
;
Hidetoshi Tsuboi
;
Nobuya Zempo
;
Shoichi Furukawa
;
Tatsuro Oda
;
Masaki Miyamoto
- Publication Type:Journal Article
- Keywords:
QOL
- From:Japanese Journal of Cardiovascular Surgery
1997;26(4):230-234
- CountryJapan
- Language:Japanese
-
Abstract:
From April 1990 to August 1995, 44 consecutive patients (25 males and 19 females; mean age, 63 years) who underwent surgery for Stanford type A aortic dissection, were studied to examine surgical results and postoperative quality of life (QOL). Ascending aortic replacement was performed in 22 patients and simultaneous replacement of the ascending aorta and the aortic arch in 22. The postoperative 30-day survival rate was 84% (37/44). Univariate analysis revealed that operation time (p<0.01), postoperative cardiac failure (p<0.02), respiratory failure (p<0.01), severe brain damage (p<0.01), and intestinal ischemia (p<0.02) were significant factors in increased operative mortality risk. Additional operative procedure was also a significant factor (p<0.05) all 3 patients with coronary artery bypass grafting died, while all 5 patients with the Bentall or Cabrol procedure lived. The factors which influenced postoperative QOL were preoperative renal damage (p<0.05), history of cerebral vascular disease (p<0.02), shock (p<0.02), postoperative renal failure (p<0.02), paraplegia (p<0.02), and residual dissection (p<0.02). The operation method, which was replacement of the ascending aorta or simultaneous replacement of the ascending aorta and the aortic arch, had no influence on postoperative QOL. Five of 22 patients receiving ascending aorta replacement had dissection only in the ascending aorta (localized type). The other 17 patients receiving ascending aorta replacement had dissections extending to the arch or descending aorta. The incidence of complications due to residual dissection was 5/17 (29%) in cases of replacement of the ascending aorta for type A aortic dissection, while it was 1/22 (5%) in cases of replacement of the ascending aorta and the aortic arch (p=0.0684). Simultaneous replacement of the ascending aorta and the aortic arch did not negatively affect the surgical results and postoperative QOL more than replacement of the ascending aorta, and there was lower incidence of postoperative complications due to residual dissection. If Stanford type A aortic dissection extends to the arch, simultaneous replacement of the ascending aorta and the aortic arch is recommended.
