Original article
Adult cardiac
Octogenarians With Uncomplicated Acute Type A Aortic Dissection Benefit From Emergency Operation

https://doi.org/10.1016/j.athoracsur.2013.04.066Get rights and content

Background

The management of acute type A aortic dissection (aTAAD) in octogenarian patients is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.

Methods

Beginning in January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 79 consecutive patients enrolled up to December 2010. Their median age was 81.6 years (range, 80 to 89 years). Sixteen patients (20%) presented a complicated type because of a neurologic deficit, mesenteric ischemia, a requirement for cardiopulmonary resuscitation, or some combination of those features. Operations followed the standard procedure recommended for younger patients. Follow-up was 95% complete (mean, 4.6 ± 2.8 years).

Results

The overall in-hospital mortality was 44.3%. The in-hospital mortality among patients with uncomplicated aTAAD was 33.3%. Multivariate analysis identified complicated aTAAD as the only risk factors for in-hospital mortality (p < 0.0001). Postoperative complications occurred in 50 patients (68.5%) and were associated with a higher mortality (p < 0.0001). The overall survival was 53% at 1 year and 32% at 5 years. In uncomplicated aTAAD, the overall survival was 63% at 1 year and 38% at 5 years.

Conclusions

Octogenarians with uncomplicated aTAAD benefit from emergency surgical repair. In those patients, early and midterm outcomes are good and are similar to those in published series of younger patients. Complicated aTAAD should be medically managed.

Section snippets

Registry of Octogenarian Patients Operated on for Acute Type A Aortic Dissection

This registry aims to assess the risk factors for in-hospital mortality, the incidence of postoperative complications, and the outcomes in octogenarian patients operated on for aTAAD. Quality of life was not investigated. (Appendix).

Acute type A aortic dissection was defined as involvement of the ascending aorta presenting within 14 days of the onset of symptoms. Beginning January 1, 2000, all patients who were operated on for aTAAD at the participating centers and were 80 or more years old

Study Population

During the study period, 654 patients underwent operations for aTAAD at the participating centers. Among these, 79 (12.1%) patients were octogenarians and were enrolled in the registry (Table 1). The mean age was 81.6 ± 2 years (range. 80–89 years); 9 patients (11.4%) were aged 85 years or more. The majority of patients had a history of hypertension (72.1%). Coronary artery disease (13.9%) was frequent. Four patients (5%) had a history of previous aortic valve replacement.

The clinical

Comment

The question whether surgical therapy should be proposed to patients needs to be guided by the capacity of that approach to reverse the bad prognosis of the disease. Information about the survival of medically treated patients with aTAAD is sparse. The International Registry of Acute Aortic Dissection investigation reported an in-hospital mortality rate of 45% to 62% in octogenarians denied surgical intervention because of their advanced age or comorbidity [7].

The published survival among

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