Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians

• Published in: The Annals of thoracic surgery Vol. 82; no. 2; pp. 554 - 559
• Main Authors: Shiono, Motomi, Hata, Mitsumasa, Sezai, Akira, Iida, Mitsuru, Yagi, Shinya, Negishi, Nanao
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.08.2006; Elsevier Science
• Subjects: Acute Disease; Adult; Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Biological and medical sciences; Emergencies; Female; Follow-Up Studies; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Risk Factors; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the respiratory system; Survival Rate; 26; Human; Dissecting aneurysm; Treatment; Respiratory disease; Acute; Surgery; Aorta; Thorax; Emergency; Elderly
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2005.12.048

Emergency surgery for acute type A dissection is associated with a high mortality rate in aged patients. This study was designed to explore perioperative risk factors and prognosis in octogenarians with acute type A aortic dissection. Twenty-four octogenarians, of 134 consecutive patients with acute type A dissection between 1995 and 2005 who underwent emergency surgery, were reviewed. The median age was 82 years (80 to 90); the patients were 10 men and 14 women. All 24 patients underwent conservative tear-oriented surgery under deep hypothermic circulatory arrest with cerebral perfusion; the procedures were 23 ascending aortic replacements and one entire arch replacement. The hospital mortality rate was 13% (3 of 24 patients), without statistical significance compared with 6% in patients younger than 80 years. The late mortality rate was 38% (9 of 24 patients), with significance compared with 9% in the other patients. Five- and 10-year survivals ware 55% and 42%, respectively, compared with 83% and 73%, respectively ( p = 0.0013), in the other patients. Univariate and multivariate analysis demonstrated that age 80 or greater was not an independent risk factor of hospital death. Risk factors of late death in younger-aged patients were pneumonia and reoperation. Emergency surgery for octogenarians with acute type A aortic dissection was successfully performed using a conservative intimal tear-oriented procedure, resulting in satisfactory early and late survival. Aggressive surgical treatment is mandatory for improving the outcome of this medical emergency in octogenarians.