Surgery for acute type A aortic dissection: is advanced age a contraindication?
BACKGROUND
With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The purpose of this study was to demonstrate early and late results of surgery for aortic dissection in patients older than 70 years of age compared with those younger than 70 years and to clarify the clinical problems related to this subset of patients.


METHODS
Between 1976 and 2001, 315 patients underwent emergency operation for acute type A dissection: 245 were younger than 70 years (group 1) and 70 patients were 70 years of age and older (group 2). Early and late outcomes of both groups were compared.


RESULTS
The hospital mortality rates were 20.5% in group 1 and 17.6% in group 2 (p = 0.751). The mean extracorporeal circulation time was 192.6 +/- 65.2 minutes and 185.7 +/- 58.4 minutes in groups 1 and 2, respectively (p = 0.42). The mean cross-clamp time was 116.3 +/- 45.8 minutes and 100 +/- 36.7 minutes in groups 1 and 2, respectively (p = 0.009). Actuarial survival rates were 77.1% after a mean follow-up time of 259 +/- 9 months for patients of group 1 and 80% after 77 +/- 5 months for patients of group 2, without any statistically significant difference (p = 0.619).


CONCLUSIONS
No significant differences were observed in the 30-day mortality and actuarial survival between the two groups. Therefore we believe that surgery for type A acute aortic dissection in patients 70 years of age or older can be performed with acceptable risk of death and satisfactory results.
Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. bruno_chiappini@hotmail.com
Bruno
B
Chiappini
M Erwin
ME
Tan
Wim
W
Morshuis
Hans
H
Kelder
Karl
K
Dossche
Marc
M
Schepens
D000206:Actuarial Analysis; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000145:classification / Q000209:etiology / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001014:Aortic Aneurysm / Q000145:classification / Q000209:etiology / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data; D000075202:Contraindications; D005112:Extracorporeal Circulation; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008382:Marfan Syndrome / Q000150:complications; D008875:Middle Aged; D018579:Patient Selection; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome