التفاصيل البيبلوغرافية
| العنوان: |
Proximal aortic repair in dialysis patients: A national database analysis. |
| المؤلفون: |
Ogami, Takuya, Zimmermann, Eric, Zhu, Roger C., Zhao, Yanling, Ning, Yuming, Kurlansky, Paul, Stevens, Jacob S., Avgerinos, Dimitrios V., Patel, Virendra I., Takayama, Hiroo |
| المصدر: |
Journal of Thoracic & Cardiovascular Surgery; Jan2023, Vol. 165 Issue 1, p31-31, 1p |
| مستخلص: |
Dialysis is a well-established risk factor for morbidity and mortality after cardiovascular procedures. However, little is known regarding the outcomes of proximal aortic surgery in this high-risk cohort. Perioperative (in-hospital or 30-day mortality) and 10-year outcomes were analyzed for all the patients who underwent open proximal aortic repair with the diagnosis of nonruptured thoracic aortic aneurysm (aneurysm, n = 325) or type A aortic dissection (dissection, n = 461) from 1987 to 2015 using the US Renal Data System database. In patients with aneurysm, perioperative mortality was 12.6%. The 10-year mortality was 81% ± 3%. Age 65 years or more (hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.03 to 1.78; P =. 03), chronic obstructive pulmonary disease (HR, 1.68; 95% CI, 1.01-2.82; P =. 047), and Black race (HR, 1.46; 95% CI, 1.09-1.97; P =. 01) were independently associated with worse 10-year mortality. In patients with dissection, perioperative mortality was 24.3% and 10-year mortality was 87.9% ± 2.2%. Age 65 years or more (HR, 1.49; 95% CI, 1.19-1.86; P <. 001), congestive heart failure (HR, 1.39; 95% CI, 1.11-2.57; P =. 004), and diabetes mellitus as the cause of dialysis (HR, 1.75; 95% CI, 1.2-2.57; P =. 004) were independently associated with worse 10-year mortality. Black race (HR, 0.74; 95% CI, 0.6-0.92; P =. 008) was associated with a better outcome. We described challenging perioperative and 10-year outcomes for dialysis patients undergoing proximal aortic repair. The present study suggests the need for careful patient selection in the elective repair of proximal aortic aneurysm for dialysis-dependent patients, whereas it affirms the feasibility of emergency surgery for acute type A aortic dissections. [Display omitted] [ABSTRACT FROM AUTHOR] |
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