Outcomes in the current surgical era following operative repair of acute Type A aortic dissection in the elderly: a single-institutional experience

• Published in: Interactive cardiovascular and thoracic surgery 2013-07, Vol.17 (1), p.104-109
• Main Authors: Kilic, Ahmet, Tang, Richard, Whitson, Bryan A., Sirak, John H., Sai-Sudhakar, Chittoor B., Crestanello, Juan, Higgins, Robert S.D.
• Format: Article
• Language: English
• Subjects: Acute Disease; Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Chi-Square Distribution; Emergencies; Female; Humans; Kaplan-Meier Estimate; Male; Ohio; Original; Patient Selection; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Vascular Surgical Procedures - adverse effects; Vascular Surgical Procedures - mortality
• ISSN: 1569-9293; 1569-9285
• DOI: 10.1093/icvts/ivt155

OBJECTIVES We reviewed our single-centre experience with emergent operative repair of Stanford Type A aortic dissections, with particular attention to outcomes in the elderly. METHODS Consecutive adult patients undergoing emergent operative repair of acute Type A aortic dissections between February 2004 and December 2011 at a single institution were identified. Patients were stratified into elderly (≥70 years) and control cohorts (0.05) and the presence of malperfusion at presentation (elderly: 19.4 vs controls: 27.9%, P = 0.35). The most common site of tear involved the proximal ascending aorta (elderly: 83.9 vs controls: 84.9%), with fewer cases affecting the aortic arch (12.9 vs 14.0%; P = 0.75). Operative data, including cardiopulmonary bypass and aortic cross-clamp time, concomitant aortic valve procedures and arch replacement were also similar between cohorts. Fewer elderly patients underwent hypothermic circulatory arrest (67.7 vs 90.7%, P = 0.002). Overall survival to discharge was 87.2% (n = 102), with no difference in the elderly (83.9%; n = 26) vs controls (88.4%; n = 76; P = 0.52). The 30-day (elderly: 82.8 vs controls: 86.2%), 90-day (elderly: 79.0 vs controls: 84.8%) and 1-year (elderly: 75.4 vs controls: 84.8%) survivals were also comparable. CONCLUSIONS Excellent operative outcomes can be achieved in elderly patients undergoing emergent repair of Type A aortic dissections. Advanced patient age should therefore not serve as an absolute contraindication to operative repair in this high-risk cohort.