title: Outcomes of contemporary emergency open surgery for type A acute aortic dissection in elderly patients.
abstract: OBJECTIVE
  We sought to evaluate surgical outcomes of type A acute aortic dissection in elderly patients.
  
  
  METHODS
  Between January 2004 and July 2011, 422 patients underwent emergency open surgery for type A acute aortic dissection at our institution. Of those, 124 patients who were ≥75 years (mean age, 78.6 ± 3.4 years) were reviewed. We also reviewed 26 patients (≥75 years old) who were diagnosed with acute aortic dissection at our institution during the same period but who did not undergo surgery. We analyzed early and late outcomes of surgical and nonsurgical patients.
  
  
  RESULTS
  The operative mortality was 4.8% (6/124), and the incidences of stroke and prolonged hospital stay (>30 days) were 17.7% (22/124) and 20.1% (25/124), respectively. The actuarial survivals at 1, 3, and 5 years were 89.3%, 84.7%, and 79.1%, respectively. Predictors of stroke are preoperative cardiopulmonary resuscitation (odds ratio, 17.5; 95% confidence interval, 3.1-98.9; P = .001) and previous cardiac surgery (odds ratio, 14.0; 95% confidence interval, 1.2-164.7; P = .036). The 30-day or in-hospital mortality of patients who were indicated for surgery but refused surgery was 63.6% (7/11).
  
  
  CONCLUSIONS
  Emergency open surgery for type A acute aortic dissection in elderly patients resulted in a low mortality but high incidences of stroke and prolonged hospital stay. Preoperative cardiopulmonary resuscitation and previous cardiac surgery were significant predictors of stroke. Emergency surgery is still the primary option for most elderly patients with acute aortic dissection.
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart institute, Tokyo, Japan.
authors.forename: Akihito
authors.initials: A
authors.lastname: Matsushita
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart institute, Tokyo, Japan. Electronic address: mtabata@post.harvard.edu.
authors.forename: Minoru
authors.initials: M
authors.lastname: Tabata
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart institute, Tokyo, Japan.
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Fukui
authors.affiliation: Clinical Research Center, Graduate School of Medicine, Chiba University, Chiba, Japan.
authors.forename: Yasunori
authors.initials: Y
authors.lastname: Sato
authors.affiliation: Department of Cardiovascular Surgery, Teikyo University Hospital, Tokyo, Japan.
authors.forename: Shigefumi
authors.initials: S
authors.lastname: Matsuyama
authors.affiliation: Department of Cardiovascular Surgery, Teikyo University Hospital, Tokyo, Japan.
authors.forename: Tomoki
authors.initials: T
authors.lastname: Shimokawa
authors.affiliation: Department of Cardiovascular Surgery, Sakakibara Heart institute, Tokyo, Japan.
authors.forename: Shuichiro
authors.initials: S
authors.lastname: Takanashi
mesh_terms: D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016887:Cardiopulmonary Resuscitation / Q000009:adverse effects; D004630:Emergencies; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D016017:Odds Ratio; D012086:Reoperation; D012307:Risk Factors; D020521:Stroke / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality