title: Surgery for acute type A aortic dissection: the effect of antegrade selective cerebral perfusion on the early outcome of elderly patients.
abstract: BACKGROUND
  The aim of this study was to evaluate early results and to determine predictive risk factors associated with an adverse outcome in elderly patients after acute type A aortic dissection repair using antegrade selective cerebral perfusion (ASCP). Adverse outcome was defined as the occurrence of death or permanent neurologic dysfunction.
  
  
  METHODS
  From October 1995 to March 2002, 178 patients (group A < 75 years, n = 156, 87.6%; group B > 75 years, n = 22, 12.4%) underwent surgery for acute type A aortic dissection using ASCP and moderate hypothermia. An ascending aorta/hemiarch replacement was performed in 128/178 (71.9%) patients (group A 71.2%, group B 77.3%, p = NS), an ascending aorta and arch replacement in 50/178 (28.1%) patients (group A 28.8%, group B 22.7%, p = NS). Associated procedures were performed in 55/178 (20.9%) patients (group A 31.4%, group B 27.3%, p = NS), the arch vessels were reimplanted using the separated graft technique in 32/50 (64.0%) patients (group A 62.2%, group B 80.0%, p = NS). The mean ASCP time was 59 +/- 27 min.
  
  
  RESULTS
  The overall adverse outcome rate was 20.8% (group A 21.2%, group B 18.2%, p = NS). The transient neurologic dysfunction rate was 9.5% (group A 9.5%, group B 5.6%, p = NS). A logistic regression analysis revealed cardiopulmonary bypass time (p = 0.045, odds ratio 1.03/min) to be the only independent predictor of adverse outcome in group A.
  
  
  CONCLUSIONS
  During type A aortic dissection repair the implementation of ASCP resulted in an acceptable hospital mortality and neurologic outcome. If ASCP is used, the risk of hospital mortality and postoperative morbidity is similar in patients younger and older than 75 years. Duration of cardiopulmonary bypass still remains an important risk factor for hospital mortality and neurologic outcome in elderly patients.
authors.affiliation: Department of Cardiovascular Surgery, Santa Maria Hospital, Bari, Italy. m_dieus@hotmail.com
authors.forename: Marco
authors.initials: M
authors.lastname: Di Eusanio
authors.forename: Marc A A M
authors.initials: MA
authors.lastname: Schepens
authors.forename: Wim J
authors.initials: WJ
authors.lastname: Morshuis
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
authors.forename: Davide
authors.initials: D
authors.lastname: Pacini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Eusanio
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000714:Anastomosis, Surgical; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010477:Perfusion; D011183:Postoperative Complications / Q000517:prevention & control; D011336:Probability; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000517:prevention & control*; D015996:Survival Rate; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures