Is Conventional Open Repair Still a Good Option for Aortic Arch Aneurysm in Patients of Advanced Age?

• Published in: The Annals of thoracic surgery Vol. 101; no. 1; pp. 80 - 86
• Main Authors: Oda, Tatsuya, MD, Minatoya, Kenji, MD, PhD, Sasaki, Hiroaki, MD, PhD, Tanaka, Hiroshi, MD, PhD, Seike, Yoshimasa, MD, Itonaga, Tatsuya, MD, Inoue, Yosuke, MD, Kobayashi, Junjiro, MD, PhD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 2016
• Subjects: Aged; Aged, 80 and over; Aorta, Thoracic; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Blood Vessel Prosthesis; Cardiothoracic Surgery; Female; Follow-Up Studies; Humans; Japan - epidemiology; Male; Retrospective Studies; Surgery; Survival Rate - trends; Thoracotomy - methods; Time Factors; Treatment Outcome; Vascular Surgical Procedures - methods; Japan
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2015.06.064

Background Although thoracic endovascular aortic repair has advantages in elderly patients, it is not always applicable, and some elderly patients require open surgical repair. Methods Between 2008 and 2014, 157 patients (11 men) older then 75 years (mean age, 79.3 ± 3.3 years) underwent conventional total arch replacement, of which 39 were emergency operations. Coexisting diseases included remote stroke in 54 patients, coronary artery disease in 64, chronic obstructive pulmonary disease in 25, and chronic kidney disease in 112. Concomitant procedures were performed in 46 patients. Results Mean follow-up time was 2.9 ± 1.8 years. Mean cardiopulmonary bypass time was 251.1 ± 68.4 minutes. Mean lowest nasopharyngeal temperature was 23.2° ± 3.4°C. The hospital mortality rate was 7.6% (12 of 157) overall, 5.1% in elective cases, and 15.4% in emergency cases. Postoperative complications included permanent neurologic dysfunction in 5.7% of patients and prolonged ventilation time exceeding 72 hours in 13.4%. No spinal cord complications occurred. The 1-year and 5-year survival rates were 88.2% and 69.2% in all cases and 91.3% and 77.0% in elective cases, respectively. Univariate analysis demonstrated that risk factors for hospital death in elective cases were chronic kidney disease (odds ratio, 4.00; p  = 0.028) and ventilation time exceeding 72 hours (odds ratio, 13.3; p  = 0.001). Conclusions Even in patients older than 75 years, recent surgical results of conventional open arch repair were acceptable, especially in elective cases. Thus, conventional open surgical aortic arch replacement remains a good option, especially in patients with preserved renal function.