Emergency surgery for acute type a aortic dissection in octogenarians.
BACKGROUND
Emergency surgery for acute type A dissection is associated with a high mortality rate in aged patients. This study was designed to explore perioperative risk factors and prognosis in octogenarians with acute type A aortic dissection.


METHODS
Twenty-four octogenarians, of 134 consecutive patients with acute type A dissection between 1995 and 2005 who underwent emergency surgery, were reviewed. The median age was 82 years (80 to 90); the patients were 10 men and 14 women. All 24 patients underwent conservative tear-oriented surgery under deep hypothermic circulatory arrest with cerebral perfusion; the procedures were 23 ascending aortic replacements and one entire arch replacement.


RESULTS
The hospital mortality rate was 13% (3 of 24 patients), without statistical significance compared with 6% in patients younger than 80 years. The late mortality rate was 38% (9 of 24 patients), with significance compared with 9% in the other patients. Five- and 10-year survivals ware 55% and 42%, respectively, compared with 83% and 73%, respectively (p = 0.0013), in the other patients. Univariate and multivariate analysis demonstrated that age 80 or greater was not an independent risk factor of hospital death. Risk factors of late death in younger-aged patients were pneumonia and reoperation.


CONCLUSIONS
Emergency surgery for octogenarians with acute type A aortic dissection was successfully performed using a conservative intimal tear-oriented procedure, resulting in satisfactory early and late survival. Aggressive surgical treatment is mandatory for improving the outcome of this medical emergency in octogenarians.
Shiono
Motomi
M
Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan. mshiono@med.nihon-u.ac.jp
Hata
Mitsumasa
M
Sezai
Akira
A
Iida
Mitsuru
M
Yagi
Shinya
S
Negishi
Nanao
N
D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D015996:Survival Rate