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Outcomes After Surgical Treatment for Type A Acute Aortic Dissection in Octogenarians: A Multicenter Study

2009; Elsevier BV; Volume: 88; Issue: 2 Linguagem: Inglês

10.1016/j.athoracsur.2009.04.096

1552-6259

Alessandro Piccardo, Tommaso Regesta, Konstantinos Zannis, Vlad Gariboldi, Stefano Pansini, Michel Tapia, Giovanni Concistrè, Frédéric Collart, P Kreitmann, Matthias Kirsch, Luigi Martinelli, Giancarlo Passerone, Thierry Caus,

Hip and Femur Fractures

Background Management of octogenarian patients with acute type A acute aortic dissection is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations. Methods Beginning January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 57 consecutive patients enrolled up to December 2006. Their median age was 82 (range, 80 to 89 years). Compassionate indication operations were attempted in 2 moribund patients and in 5 presenting with shock associated with neurologic symptoms or renal failure, or both. Operations followed the standard procedure recommended in younger patients. Follow-up was 100% complete (mean, 3.9 ± 2 years; range, 5 months to 8 years). Results There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication ( p ≤ 0.0001) and total arch replacement ( p = 0.0060) as risk factors for in-hospital mortality. Postoperative complications occurred in 36 patients (69.2%) and were associated with a higher mortality ( p = 0.0001). Overall survival was 51% at 1 year and 44% at 5 years. Excluding patients with compassionate indication and those who underwent total arch replacement, or both, overall survival was 66% at 1 year and 57% at 5 years. Conclusions Surgical treatment for type A acute aortic dissection in octogenarians shows satisfactory midterm results among survivors. However, the high mortality rate imposes a requirement for better perioperative management. Compassionate cases should be managed medically. A less aggressive approach should improve outcomes of surgical treatment.