Quality of life and survival of septuagenarians and octogenarians after repair of descending and thoracoabdominal aortic aneurysms

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 145; no. 2; pp. 378 - 384
• Main Authors: Di Luozzo, Gabriele, MD, Shirali, Aditya S., BS, Varghese, Robin, MD, Lin, Hung-Mo, ScD, Weiss, Aaron J., MD, Bischoff, Moritz S., MD, Griepp, Randall B., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01.02.2013
• Subjects: Age Factors; Aged; Aged, 80 and over; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Cardiothoracic Surgery; Female; Hospital Mortality; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Odds Ratio; Proportional Hazards Models; Quality of Life; Respiratory Distress Syndrome, Adult - etiology; Respiratory Distress Syndrome, Adult - mortality; Retrospective Studies; Risk Assessment; Risk Factors; Sex Factors; Surveys and Questionnaires; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality; OR; standardized mortality ratio; CI; TAAA; odds ratio; Medical Outcomes Study Short Form 36; descending thoracic aortic aneurysm; QoL; SF-36; 26.1; DTA; thoracic endovascular aortic repair; TEVAR; acute respiratory distress syndrome; SMR; confidence interval; thoracoabdominal aortic aneurysm; quality of life; ARDS; COPD; chronic obstructive pulmonary disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.01.068

Objective We assessed quality of life and survival in elderly patients after complex aortic operations to aid in surgical decision making. Methods A retrospective review was performed of 93 patients who underwent descending thoracic aneurysm or thoracoabdominal aortic aneurysm (TAAA) repair from 2002 to 2008. A Cox model was used for survival analysis. The SF-36 Item Health Survey was administered to assess postoperative quality of life in 39 patients and was compared with age- and gender-matched normal scores. Results The mean age at operation was 75 ± 4.1 years; 51% of patients were male. In-hospital mortality was 15%. One-year survival was 69%, and 5-year survival was 45%. Only acute respiratory distress syndrome was a predictor of in-hospital mortality (hazard ratio = 3.75; P  < .01) and 1-year mortality (hazard ratio = 4.61; P  < .001). After 1 year, patients enjoyed longevity equivalent to that of a normal age- and gender-matched population (standardized mortality ratio = 1.06; P  = .81). Being male is a predictor of long-term survival (hazard ratio = 0.18; P  < .05). For women, extremely low and high body mass indexes (quadratic term = 0.020; P  < .05) with an inflection point of body mass index of 28 is a risk factor of long-term survival. Quality of life scores were similar to those of the general population except for lower vitality scores, (s-score = −0.67, 95% CI, −1.09 to −0.26). Conclusions TAAA repair in this selected older surgical population yields acceptable survival beyond the first year. Among 1-year survivors, quality of life is similar to that of an age- and gender-matched population.