Background

Immediate surgery to save life is the recommended treatment for Stanford type A acute aortic dissection (AAAD).

Method

The present study comprised 35 patients admitted with AAAD who were considered inappropriate candidates for surgery or declined surgery. The mean age was 84.5 ± 9.6 years. Eight patients who were considered inappropriate candidates for surgery due to severe stroke in 2 patients or hemodynamic instability in 6. Twenty-seven patients aged 88.0 ± 5.9 years who declined surgery, predominantly due to advanced age.

Results

The overall in-hospital mortality was 51.4%. Mortality among patients that declined surgery or were considered inappropriate candidates for surgery were 37% and 100%, respectively. Causes of death among patients that declined surgery were cardiac tamponade in 6 and aortic rupture in 4. Mid-term survival among patients who refuse surgery, including in-hospital death, were 51.6 ± 10% and 34.5 ± 10%, on the other hand, Mid-term survival in hospital survivors were 81.9 ± 9% and 54.8 ± 14%. The causes of death among the discharged patients were senility in three, malignant tumor in two, pneumonia, aortic rupture, and unknown cause in one each.

Conclusions

Mortality from AAAD is 51.4%, including inappropriate candidates for surgery. When patients were evaluated as suitable candidates for surgical intervention but subsequently refused the surgical procedure, in-hospital mortality was 37%. Long-term survival of hospital survivor was acceptable. These data can be a benchmark for patient and patient’s family to select medical therapy for AAAD in consideration with the patient’s will.

中文翻译：

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急性 A 型主动脉夹层非手术治疗后的预后

背景

立即手术挽救生命是斯坦福 A 型急性主动脉夹层 (AAAD) 的推荐治疗方法。

方法

本研究包括 35 名因 AAAD 入院的患者，他们被认为不适合手术或拒绝手术。平均年龄为 84.5 ± 9.6 岁。8 名患者因 2 名患者严重中风或 6 名血流动力学不稳定而被认为不适合手术。27 名年龄为 88.0 ± 5.9 岁的患者拒绝手术，主要是由于高龄。

结果

总体院内死亡率为51.4%。拒绝手术或被认为不适合手术的患者的死亡率分别为 37% 和 100%。拒绝手术的患者的死亡原因为心脏压塞（6 例）和主动脉破裂（4 例）。另一方面，拒绝手术的患者（包括院内死亡）的中期生存率为 51.6 ± 10% 和 34.5 ± 10% ，医院幸存者的中期生存率为81.9±9%和54.8±14%。出院患者死亡原因为衰老3例，恶性肿瘤2例，肺炎、主动脉破裂、原因不明各1例。

结论

AAAD 的死亡率为 51.4%，其中包括不适合手术的患者。当患者被评估为适合进行手术干预但随后拒绝手术时，院内死亡率为 37%。医院幸存者的长期生存是可以接受的。这些数据可以作为患者和患者家属根据患者意愿选择AAAD药物治疗的基准。