Outcomes after surgical treatment for type A acute aortic dissection in octogenarians: a multicenter study.
BACKGROUND
Management of octogenarian patients with acute type A acute aortic dissection is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.


METHODS
Beginning January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 57 consecutive patients enrolled up to December 2006. Their median age was 82 (range, 80 to 89 years). Compassionate indication operations were attempted in 2 moribund patients and in 5 presenting with shock associated with neurologic symptoms or renal failure, or both. Operations followed the standard procedure recommended in younger patients. Follow-up was 100% complete (mean, 3.9 +/- 2 years; range, 5 months to 8 years).


RESULTS
There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication (p < or = 0.0001) and total arch replacement (p = 0.0060) as risk factors for in-hospital mortality. Postoperative complications occurred in 36 patients (69.2%) and were associated with a higher mortality (p = 0.0001). Overall survival was 51% at 1 year and 44% at 5 years. Excluding patients with compassionate indication and those who underwent total arch replacement, or both, overall survival was 66% at 1 year and 57% at 5 years.


CONCLUSIONS
Surgical treatment for type A acute aortic dissection in octogenarians shows satisfactory midterm results among survivors. However, the high mortality rate imposes a requirement for better perioperative management. Compassionate cases should be managed medically. A less aggressive approach should improve outcomes of surgical treatment.
Piccardo
Alessandro
A
Amiens Picardie University Hospital, Amiens, France. piccardo.alessandro@chu-amiens.fr
Regesta
Tommaso
T
Zannis
Konstantinos
K
Gariboldi
Vlad
V
Pansini
Stefano
S
Tapia
Michel
M
Concistré
Giovanni
G
Collart
Frédéric
F
Kreitmann
Patrice
P
Kirsch
Matthias E W
ME
Martinelli
Luigi
L
Passerone
Giancarlo
G
Caus
Thierry
T
D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery; D005260:Female; D006333:Heart Failure / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D007902:Length of Stay; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome