OBJECTIVE:Ascending aortic atherosclerosis is a risk factor for perioperative morbidity and mortality in coronary surgery. It was the aim of our study to determine the role of atherosclerosis of the ascending aorta and other factors for the survival rate during long-term follow-up after CABG. METHODS:From 500 out of 580 CABG patients (aged 67 (33-85) years, 77% male), who underwent intraoperative epiaortic ultrasound for assessment of ascending aortic wall thickness, a complete follow up regarding long-term survival was achieved. The median follow-up time was 55 (1-78) months. RESULTS:53/500 (11%) patients died within the follow-up period, and the cumulative survival rate was 95, 90, and 84% after 1, 3, and 5 years, respectively (including hospital deaths). A significantly lower long-term survival was present in patients with: an age of 70 years or more (P<0.001), COPD (P=0.005), preoperative elevated serum creatinine of >1.2mg/dl (P=0.007), preoperative LVEF <40% (P=0.033), ascending aortic wall thickness of 4mm or more (P=0.001), carotid artery disease (P<0.001), peripheral vascular disease (P<0.001), and acute operation (P=0.009). Multivariate analysis revealed carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age to be independent risk factors. CONCLUSION:Patients with ascending aortic atherosclerosis are at risk for a decreased long-term survival after CABG. Besides, preoperative elevated serum creatinine, COPD, carotid artery disease, LVEF <40%, peripheral vascular disease, and advanced age are risk factors for a decreased long-term survival after CABG.

译文

目的:升主动脉粥样硬化是冠状动脉手术围手术期发病和死亡的危险因素。本研究的目的是确定CABG术后长期随访中升主动脉的动脉粥样硬化的作用以及其他因素对存活率的影响。
方法:在580例CABG患者(年龄67岁(33-85岁),男性77%)中,有500例接受了术中表皮超声检查以评估主动脉壁厚度的增加,从而获得了关于长期生存的完整随访。中位随访时间为55(1-78)个月。
结果:53/500(11%)患者在随访期内死亡,在1、3和5年后(包括医院死亡),累积生存率分别为95%,90%和84%。年龄在70岁或以上(P <0.001),COPD(P = 0.005),术前血清肌酐升高> 1.2mg / dl(P = 0.007)的患者的远期生存率显着降低LVEF <40%(P = 0.033),升主动脉壁厚4mm以上(P = 0.001),颈动脉疾病(P <0.001),周围血管疾病(P <0.001)和急性手术(P = 0.009) 。多因素分析显示,颈动脉疾病,LVEF <40%,周围血管疾病和高龄是独立的危险因素。
结论:升主动脉粥样硬化的患者有CABG术后长期生存降低的风险。此外,术前血清肌酐升高,COPD,颈动脉疾病,LVEF <40%,周围血管疾病和高龄是CABG术后长期生存率降低的危险因素。

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