title: Is treatment of acute type A aortic dissection in septuagenarians justifiable?
abstract: This study was undertaken to analyze the risk of mortality and neurological complications after treatment of acute type A aortic dissection in septuagenarians. From 1996 through 2002, 24 patients > 70 years underwent surgery for acute type A aortic dissection. Their median age was 75 years (range, 71-82 years), and 15 were male. Eleven (46%) had previous neurological events, 22% presented with hemodynamic instability and aortic rupture was found in 7%. Ten had hypothermic circulatory arrest alone, 3 had it in combination with retrograde cerebral perfusion and 11 had selective antegrade cerebral perfusion as an adjunct. The overall survival rate was 71% (17/24). Temporary neurological dysfunction was found in 3 (12.5%), and permanent neurological dysfunction in 9 (37.5%), leading to death in 3. Comparison of mortality rates and neurological outcome showed a marked tendency towards better outcome in patients who had hypothermic circulatory arrest and selective antegrade cerebral perfusion. Surgery for aortic dissections in the elderly can be performed with acceptable mortality, but there is a high rate of neurological complications. Despite the small number of patients, selective antegrade cerebral perfusion seemed to reduce the incidence of neurological events.
authors.affiliation: Division of Cardiothoracic and Vascular Surgery, Hannover Medical School, Carl Neuberg Str. 1, 30625 Hannover, Germany. Malawshr@yahoo.com
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.forename: Nawid
authors.initials: N
authors.lastname: Khaladj
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.forename: Christian
authors.initials: C
authors.lastname: Hagl
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001019:Aortic Rupture / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D009422:Nervous System Diseases / Q000209:etiology* / Q000401:mortality / Q000503:physiopathology; D018579:Patient Selection; D010477:Perfusion; D012189:Retrospective Studies; D018570:Risk Assessment; D020521:Stroke / Q000209:etiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects*