Surgery for acute type A aortic dissection in octogenarians.
OBJECTIVE
Emergency surgery for type A aortic dissection (AAD) is associated with high mortality rates. The published outcomes of such surgery in aging patients are controversial and the optimal management for elderly patients has not been established. Our study aimed to evaluate the outcomes of surgery for AAD in patients over the age of 80 years.


METHODS
Between January 1996 and January 2010, 236 patients underwent surgery for AAD, of which 15 patients were older than 80 years. We evaluated the operative mortality in the whole cohort compared to the outcomes in the elderly subgroup. We assessed the preoperative risks factors and quality of life after surgery by performance status and the patients' ability to return home.


RESULTS
Operative mortality was higher in patients aged >80 years (40% vs. 18%, p = 0.04). The survival rate for patients >80 years at one, three, and five years was 53.3% ± 0.12%, 42.6% ± 0.14%, and 42.6% ± 0.12%, respectively. Of the survivors, six patients were able to return home (40%) and the postoperative performance status was "3" in one patient, "2" in six patients, and "1" in two patients. A preoperative level of 2 or greater was found to be a significant risk factor (p = 0.04).


CONCLUSIONS
Survival in octogenarians undergoing surgery for AAD is possible, and some patients were able to return home with a reasonable level of autonomy. Larger series will be needed to define the optimal management for octogenarians presenting with AAD.
Department of Cardiac Surgery, CHU Nancy, Vandoeuvre-Les-Nancy, France. f.vanhuyse@chu-nancy.fr
Fabrice
F
Vanhuyse
Pablo
P
Maureira
Nicolas
N
Laurent
Malik
M
Lekehal
Daniel
D
Grandmougain
Jean Pierre
JP
Villemot
D000208:Acute Disease; D000367:Age Factors; D000369:Aged, 80 and over; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D026684:Personal Autonomy; D011183:Postoperative Complications; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy; D015996:Survival Rate; D016896:Treatment Outcome