Is advanced age a contraindication for emergent repair of acute type A aortic dissection?

• Published in: Interactive cardiovascular and thoracic surgery 2010-04, Vol.10 (4), p.539-544
• Main Authors: Stamou, Sotiris C, Hagberg, Robert C, Khabbaz, Kamal R, Stiegel, Mark R, Reames, Mark K, Skipper, Eric, Nussbaum, Marcy, Lobdell, Kevin W
• Format: Article
• Language: English
• Subjects: Acute Disease; Acute Kidney Injury - etiology; Adult; Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - physiopathology; Aneurysm, Dissecting - surgery; Aortic Aneurysm - mortality; Aortic Aneurysm - physiopathology; Aortic Aneurysm - surgery; Chi-Square Distribution; Contraindications; Emergency Treatment; Female; Hemodynamics; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Patient Selection; Postoperative Hemorrhage - etiology; Postoperative Hemorrhage - surgery; Reoperation; Respiration, Artificial; Retrospective Studies; Risk Assessment; Risk Factors; Stroke - etiology; Time Factors; Treatment Outcome; United States - epidemiology; Vascular Surgical Procedures - mortality; Young Adult
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1510/icvts.2009.222984

With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The aim of our study was to investigate whether advanced age poses an increased risk for major morbidity and mortality with repair of acute type A aortic dissection. Between 2000 and 2008, 119 patients underwent emergency operation for acute type A aortic dissection at two institutions; 90 were younger than 70 years of age and 29 patients were 70 years or older. Major morbidity, operative and 5-year actuarial survival were compared between groups. The operative mortality rates were comparable between the two groups (18.9% in patients or=70 years, P=0.6). There was no difference in the rates of reoperation for bleeding (or=70 years, P=0.09), stroke (18.9% for those or=70 years, P=0.79), acute renal failure (22.2% for those or=70 years, P=0.79) or prolonged ventilation (34.4% for those or=70 years, P=0.36) between the two groups. Actuarial 5-year survival rates were 77% for patients or=70 years (P=0.07). The mortality for patients who presented with hemodynamic instability was markedly higher (10 out of 14 patients, 71.4%) compared with the mortality of those who presented with stable hemodynamics (21 out of 88 patients, 23.9%, Por=70 years and younger patients although there was a trend toward a lower actuarial 5-year survival in older patients. Surgery for type A acute aortic dissection in patients 70 years or older can be performed with acceptable outcomes. Hemodynamic instability portends a poor prognosis, regardless of age.