초록접수 현황
| 17F-177 | 구연 발표 |
Clinical Outcomes of Repeated Surgeries for Thoracic Aorta
Hunbo Shim, Chang-Seok Jeon, Wook Sung Kim, Pyo Won Park, Young Tak Lee, Kiick Sung
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
Purpose : Reoperation after aortic surgery is rare, but inevitable. We evaluated clinical outcomes of repeated surgeries for thoracic aorta.
Methods : One hundred and nineteen patients (84 males and 35 females, age 51.0±16.7 years) who had the history of thoracic aorta surgery underwent reoperation for thoracic aorta. The patients had surgeries for thoracic aorta mean 1.3±0.8 times (1-8) before the last surgery. Clinical outcomes were evaluated based on emergency, indications for operation, pathologic causes, and approach to reoperation. Approach to reoperation was classified into 4 categories according to previous and present approach; Thoracotomy-Thoracotomy, Thoracotomy-Sternotomy, Sternotomy-Thoracotomy, and Sternotomy-Sternotomy. Mean follow up period was 44.3±47.1 (0-251) months.
Results : Postoperative bleeding that needed surgical exploration was higher in emergency operation (p=0.047), repeated thoracotomy (p=0.022) and operations for infectious causes (p=0.003). Early and late mortality was 6.7% and 10.9%, respectively. Early mortality was higher in emergency operation (p=0.05) and in patients with connective tissue disorder (CTD) (p=0.05). Cox-regression analysis showed that prolonged cardiopulmonary bypass time was related to overall mortality [odds ratio (OR) = 1.012, 95% confidence interval (CI) = 1.005 – 1.019]. CTD reduced overall mortality [OR = 0.100, 95% CI = 0.017 – 0.572], showing a higher survival rate at long-term follow-up (Log-Rank test, p=0.031). Mean age of the patients with CTD was low compared to without CTD (36.2±11.1 vs 59.4±13.1, p<0.001).
Conclusion : 1) Repeated surgery for thoracic aorta is challenging with high mortality. Each condition carries different risks. 2) The mortality reduction in patients with CTD at long term follow-up may be related to young age.
Methods : One hundred and nineteen patients (84 males and 35 females, age 51.0±16.7 years) who had the history of thoracic aorta surgery underwent reoperation for thoracic aorta. The patients had surgeries for thoracic aorta mean 1.3±0.8 times (1-8) before the last surgery. Clinical outcomes were evaluated based on emergency, indications for operation, pathologic causes, and approach to reoperation. Approach to reoperation was classified into 4 categories according to previous and present approach; Thoracotomy-Thoracotomy, Thoracotomy-Sternotomy, Sternotomy-Thoracotomy, and Sternotomy-Sternotomy. Mean follow up period was 44.3±47.1 (0-251) months.
Results : Postoperative bleeding that needed surgical exploration was higher in emergency operation (p=0.047), repeated thoracotomy (p=0.022) and operations for infectious causes (p=0.003). Early and late mortality was 6.7% and 10.9%, respectively. Early mortality was higher in emergency operation (p=0.05) and in patients with connective tissue disorder (CTD) (p=0.05). Cox-regression analysis showed that prolonged cardiopulmonary bypass time was related to overall mortality [odds ratio (OR) = 1.012, 95% confidence interval (CI) = 1.005 – 1.019]. CTD reduced overall mortality [OR = 0.100, 95% CI = 0.017 – 0.572], showing a higher survival rate at long-term follow-up (Log-Rank test, p=0.031). Mean age of the patients with CTD was low compared to without CTD (36.2±11.1 vs 59.4±13.1, p<0.001).
Conclusion : 1) Repeated surgery for thoracic aorta is challenging with high mortality. Each condition carries different risks. 2) The mortality reduction in patients with CTD at long term follow-up may be related to young age.
책임저자: Kiick Sung
Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
발표자: Chang-Seok Jeon, E-mail : csjeonmd@gmail.com