title: Is advanced age a contraindication for emergent repair of acute type A aortic dissection?
abstract: With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The aim of our study was to investigate whether advanced age poses an increased risk for major morbidity and mortality with repair of acute type A aortic dissection. Between 2000 and 2008, 119 patients underwent emergency operation for acute type A aortic dissection at two institutions; 90 were younger than 70 years of age and 29 patients were 70 years or older. Major morbidity, operative and 5-year actuarial survival were compared between groups. The operative mortality rates were comparable between the two groups (18.9% in patients <70 years vs. 24.1% for patients >or=70 years, P=0.6). There was no difference in the rates of reoperation for bleeding (<70 years 31.7% vs. 14.3% for >or=70 years, P=0.09), stroke (18.9% for those <70 years vs. 20.7% for those >or=70 years, P=0.79), acute renal failure (22.2% for those <70 years vs. 17.2% for those >or=70 years, P=0.79) or prolonged ventilation (34.4% for those <70 years vs. 24.1% for those >or=70 years, P=0.36) between the two groups. Actuarial 5-year survival rates were 77% for patients <70 years vs. 59% for patients >or=70 years (P=0.07). The mortality for patients who presented with hemodynamic instability was markedly higher (10 out of 14 patients, 71.4%) compared with the mortality of those who presented with stable hemodynamics (21 out of 88 patients, 23.9%, P<0.001), regardless of age group. No significant differences in operative mortality, major morbidity and actuarial 5-year survival were observed between patients >or=70 years and younger patients although there was a trend toward a lower actuarial 5-year survival in older patients. Surgery for type A acute aortic dissection in patients 70 years or older can be performed with acceptable outcomes. Hemodynamic instability portends a poor prognosis, regardless of age.
authors.affiliation: Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
authors.forename: Mark R
authors.initials: MR
authors.lastname: Stiegel
authors.forename: Mark K
authors.initials: MK
authors.lastname: Reames
authors.forename: Eric
authors.initials: E
authors.lastname: Skipper
authors.forename: Marcy
authors.initials: M
authors.lastname: Nussbaum
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
mesh_terms: D000208:Acute Disease; D058186:Acute Kidney Injury / Q000209:etiology; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D016009:Chi-Square Distribution; D000075202:Contraindications; D004638:Emergency Treatment; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000601:surgery; D012086:Reoperation; D012121:Respiration, Artificial; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000401:mortality; D055815:Young Adult