title: Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention.
abstract: OBJECTIVE
  Controversy still exists about averting expenditure of health care resources on the growing elderly population. This study evaluates clinical outcome of patients aged 75 years and older operated upon for acute type A aortic dissection.
  
  
  METHODS
  Between January 1990 and April 2004, of 247 patients undergoing emergency operation for acute type A aortic dissection at our Institution, 40 patients (16%) were aged 75 years and older (mean 78+/-3 years, range 75-88 years) and represent the study population. On admission, 9 (22.5%) had cardiogenic shock/hypotension, 20 (50%) cardiac tamponade, 14 (35%) kidney failure, 11 (27.5%) limb ischemia, 3 (7.5%) neurologic deficit, and 1 (2.5%) myocardial ischemia. Surgical procedures included isolated replacement of the ascending aorta in 34 patients (85%), associated with total root replacement in 5 (12.5%), and with aortic valve replacement in 1 (2.5%). Eleven patients (27.5%) underwent aortic arch replacement (hemiarch: n=8, 20%; total arch: n=3, 7.5%).
  
  
  RESULTS
  In-hospital mortality was 30% (12 patients). Mortality tended to be higher (8/21, 38% vs 4/19, 21%; p=NS) for patients presenting with any one of the following complications: tamponade, shock, brain and/or myocardial, renal, limb malperfusion. Actuarial survival at 1, 5, and 7 years was 93+/-5%, 80+/-8%, and 80+/-8%, respectively, and freedom from reoperation 97+/-2%, 97+/-2%, and 97+/-2%, respectively. Actuarial event-free rates were 94+/-3%, 90+/-5%, and 90+/-5%. Seventy-four percent of survivors are in NYHA FC I, and quality of life test (RAND SF-36) revealed a generalized perception of independency and well-being, comparable to an age-matched population.
  
  
  CONCLUSIONS
  Overall results for emergency repair of acute type A aortic dissection in the elderly justify intervention, particularly in uncomplicated cases. Expeditious referral and intervention by lowering pre-operative dissection-related complications and comorbidities might help to improve results. Survivors show functional status and quality of life similar to contemporary individuals.
authors.affiliation: Division of Cardiac Surgery, University of Verona, OCM Borgo Trento, Piazzale Stefani 1, 37126 Verona, Italy. fsant@yahoo.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalbano
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.forename: Augusto
authors.initials: A
authors.lastname: D'Onofrio
authors.forename: Gianluca
authors.initials: G
authors.lastname: Casali
authors.forename: Francesca
authors.initials: F
authors.lastname: Viscardi
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Luciani
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000208:Acute Disease; D017677:Age Distribution; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000534:rehabilitation / Q000601:surgery*; D001014:Aortic Aneurysm / Q000534:rehabilitation / Q000601:surgery*; D004630:Emergencies; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D011788:Quality of Life; D016896:Treatment Outcome