title: Should octogenarians be denied access to surgery for acute type A aortic dissection?
abstract: OBJECTIVE
  Outcomes after surgery for acute type A aortic dissection in the octogenarian are controversial. To analyze this issue further, the authors reviewed their experience in the hope of finding ways to improve results in these high-risk patients.
  
  
  METHODS
  Between April 1990 and November 2006, 319 consecutive patients underwent emergency surgery for acute type A aortic dissection at the San Martino University Hospital of Genoa (Italy). Among them, 23 (7%) patients were aged 80 years or older (mean age 82 years, range 80 to 86 years) and represent the study population. On admission 7 patients (30%) had preoperative shock, 1 needed cardiopulmonary resuscitation, 7 (30%) had a neurological deficit, 2 (9%) had acute renal failure. Deep hypothermic circulatory arrest was performed in 19 patients (83%). Surgical procedures included isolated replacement of the ascending aorta in all patients associated with root replacement in 2 (9%) and total aortic arch replacement in 5 (22%). Median follow up was 4.1 years (range 3 to 83 months).
  
  
  RESULTS
  Hospital mortality was 61% (14 of 23 patients). Late mortality was 11% (1 of 9 survivors). Stepwise logistic regression identified the extension of surgery to the arch as independent risk factors for hospital death. Fourteen patients (61%) had 1 or more postoperative complications. Overall survival was 39+/-10% and 33+/-10% after 1 and 5 years respectively.
  
  
  CONCLUSIONS
  Surgery for acute type A aortic dissection in the octogenarian shows high hospital mortality but satisfactory long-term survival among discharged patients. A less aggressive approach should increase the outcomes of surgically managed patients.
authors.affiliation: Division of Cardiac Surgery, San Martino University Hospital, Genoa, Italy. alessandropiccardo@gmail.com
authors.forename: A
authors.initials: A
authors.lastname: Piccardo
authors.forename: T
authors.initials: T
authors.lastname: Regesta
authors.forename: S
authors.initials: S
authors.lastname: Pansini
authors.forename: G
authors.initials: G
authors.lastname: Concistrè
authors.forename: A
authors.initials: A
authors.lastname: Dell'Aquila
authors.forename: F
authors.initials: F
authors.lastname: Scarano
authors.forename: L
authors.initials: L
authors.lastname: Martinelli
authors.forename: G
authors.initials: G
authors.lastname: Passerone