Acute type A aortic dissection in non-agenarians: to cut or not

• Published in: Interactive cardiovascular and thoracic surgery 2020-07, Vol.31 (1), p.102-107
• Main Authors: Hattori, Shigeru, Noguchi, Kenichiro, Gunji, Yusuke, Nagatsuka, Motoki, Katayama, Ikuo
• Format: Article
• Language: English
• Subjects: Acute Disease; Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - diagnosis; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Decision Making; Female; Follow-Up Studies; Hospital Mortality - trends; Humans; Japan - epidemiology; Male; Retrospective Studies; Survival Rate - trends; Time Factors; Treatment Outcome; Vascular Surgical Procedures
• ISSN: 1569-9285; 1569-9285
• DOI: 10.1093/icvts/ivaa061

Abstract OBJECTIVES Surgery for acute type A aortic dissection (type AAD) in non-agenarians is usually contraindicated due to advanced age. The aim of this study was to assess and compare outcomes after surgical or conservative treatment for acute type AAD in non-agenarians by evaluating frailty. METHODS Between October 2012 and September 2018, 273 patients underwent open repair for type AAD at the Shonan Kamakura General Hospital and the Shonan Fujisawa Tokushukai Hospital, and here, we retrospectively reviewed the case reports of 10 surgically treated non-agenarians and 15 conservatively treated non-agenarians. Exclusion criteria for surgery were the patient’s refusal of surgery, severe dementia and coma. In patients considered to be at a high risk, our judgements were based on the results of comprehensive evaluation. RESULTS Both in-hospital mortality and 30-day mortality in the surgical group were zero, while in-hospital mortality in conservatively treated non-agenarians was 73.3%. Importantly, 1-year survival in the surgical group and conservative group was 90% and 25%, respectively. The 5-year survival in the surgical group and conservative group was 49.2% and 25%, respectively (log-rank test, P = 0.0105). Four of 6 patients with preoperative clinical frailty scores not higher than 4 were still alive at 1 year with the same level of preoperative frailty. CONCLUSIONS Surgery for acute type AAD in non-agenarians can be performed with acceptable outcomes in carefully selected patients, particularly in those with preoperative clinical frailty scores not higher than 4.