title: Thoracic aortic endografting is the treatment of choice for elderly patients with thoracic aortic disease.
abstract: OBJECTIVE
  To assess the effect of age on outcomes following thoracic aortic endografting.
  
  
  BACKGROUND
  Endograft therapy for thoracic aortic disease is rapidly evolving. This therapy is less invasive, and elderly patients with significant medical comorbidities are more frequently referred for endografting. We hypothesized that elderly patients over the age of 75 have worse outcomes after thoracic endografting than patients under the age of 75.
  
  
  METHODS
  We retrospectively reviewed the charts of the first 42 patients who underwent endografting for thoracic aortic pathology. Charts were reviewed for demographics, comorbid conditions, perioperative complications and death, endoleaks, and results at 3, 6, and 12 months. Preexisting medical conditions were also evaluated to determine if any patient characteristics were associated with adverse outcomes. Perioperative morbidity included cardiac, pulmonary, renal, hemorrhagic, and neurologic (stroke and spinal cord injury) complications.
  
  
  RESULTS
  Twenty-four patients were under the age of 75, and 18 patients were 75 or older. Baseline demographics and comorbidities were similar between the 2 groups. There were no differences in operative time, length of stay, perioperative mortality, or the incidence of significant complications between the 2 age groups. Gender, however, was associated with a statistically significant difference between the occurrence of complications, with more women experiencing complications than men (P = 0.026, relative risk = 2.36). One patient (age >75 years) in the entire cohort of 42 (2.4%) suffered a spinal cord injury. At 3 months, endoleaks were more common in the older age group (P = 0.059).
  
  
  CONCLUSIONS
  Endograft therapy for thoracic aortic disease can be performed safely in elderly patients with no significant increase in perioperative morbidity or mortality compared with younger patients. Female gender is associated with a higher likelihood of perioperative complications, regardless of age. The overall incidence of spinal cord injury is very low. Endograft therapy, when anatomically possible, is the treatment of choice for thoracic aortic disease in elderly patients.
authors.affiliation: Department of Surgery, University of Virginia Health System, Charlottesville, VA 22908, USA. jak3r@virginia.edu
authors.forename: John A
authors.initials: JA
authors.lastname: Kern
authors.forename: Alan H
authors.initials: AH
authors.lastname: Matsumoto
authors.forename: Curtis G
authors.initials: CG
authors.lastname: Tribble
authors.forename: Leo M
authors.initials: LM
authors.lastname: Gazoni
authors.forename: Benjamin B
authors.initials: BB
authors.lastname: Peeler
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Harthun
authors.forename: Tae
authors.initials: T
authors.lastname: Chong
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Cherry
authors.forename: Michael D
authors.initials: MD
authors.lastname: Dake
authors.forename: John S
authors.initials: JS
authors.lastname: Angle
authors.forename: Irving L
authors.initials: IL
authors.lastname: Kron
mesh_terms: D000328:Adult; D000368:Aged; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012189:Retrospective Studies; D016896:Treatment Outcome