title: Surgery for acute type A aortic dissection in octogenarians is justified.
abstract: OBJECTIVE
  Surgery in octogenarians with acute type A aortic dissection is commonly avoided or denied because of the high surgical morbidity and mortality reported in elderly patients. We sought to compare clinical and quality of life outcomes between octogenarians and those aged less than 80 years who underwent surgical repair at New York Medical College.
  
  
  METHODS
  A total of 101 cases of acute type A aortic dissection repair between July 2005 and December 2011 were retrospectively analyzed, comparing 21 octogenarians with 80 concurrent patients aged less than 80 years. All patients underwent corrective surgery (ascending/hemiarch replacement in 71; Bentall in 22; David procedure in 2; Wheat procedure in 4; total arch replacement in 2) using deep hypothermic circulatory arrest. During follow-up, the RAND 36-Item Short Form Health Survey Questionnaire was used to assess quality of life.
  
  
  RESULTS
  Octogenarians (average, 85 years; range, 80-91 years) were compared with the younger group (average, 60 years; range, 30-79 years). The 2 groups had similar preoperative characteristics, but the younger group experienced more malperfusion (40% vs 9%, P = .002), were more likely to have undergone a Bentall procedure (26% vs 5%, P = .04), and had longer circulatory arrest times (20 ± 7 minutes vs 16 ± 9 minutes, P = .03). The overall hospital mortality was 9% (9/101). Among octogenarians, there were no hospital deaths, no late deaths during follow-up (mean, 17 months; range, 1-59 months), and emotional health scores were better than those of the younger patients (P = .04).
  
  
  CONCLUSIONS
  Surgery for acute type A aortic dissection should be offered to octogenarians because excellent surgical and quality of life outcomes can be achieved even in this elderly population.
authors.affiliation: Department of Surgery, Section of Cardiothoracic Surgery, New York Medical College, Westchester Medical Center, Valhalla, NY, USA.
authors.forename: Gilbert H L
authors.initials: GH
authors.lastname: Tang
authors.forename: Ramin
authors.initials: R
authors.lastname: Malekan
authors.forename: Cindy J
authors.initials: CJ
authors.lastname: Yu
authors.forename: Masashi
authors.initials: M
authors.lastname: Kai
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lansman
authors.forename: David
authors.initials: D
authors.lastname: Spielvogel
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D050792:Circulatory Arrest, Deep Hypothermia Induced; D004644:Emotions; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009518:New York; D018579:Patient Selection; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D013997:Time Factors; D016896:Treatment Outcome