title: Outcomes in the current surgical era following operative repair of acute Type A aortic dissection in the elderly: a single-institutional experience.
abstract: OBJECTIVE
  We reviewed our single-centre experience with emergent operative repair of Stanford Type A aortic dissections, with particular attention to outcomes in the elderly.
  
  
  METHODS
  Consecutive adult patients undergoing emergent operative repair of acute Type A aortic dissections between February 2004 and December 2011 at a single institution were identified. Patients were stratified into elderly (≥ 70 years) and control cohorts (<70 years). Kaplan-Meier analysis was used to evaluate survival.
  
  
  RESULTS
  A total of 117 patients undergoing emergent repair of Type A aortic dissection were identified during the study period, including 31 (26.5%) elderly and 86 (73.5%) control patients. The mean age in the elderly cohort was 78.0 ± 4.7 years, with 41.9% (13 of 31) being 80 years or older. The elderly and control groups were well matched with regard to preoperative comorbidities (each P>0.05) and the presence of malperfusion at presentation (elderly: 19.4 vs controls: 27.9%, P = 0.35). The most common site of tear involved the proximal ascending aorta (elderly: 83.9 vs controls: 84.9%), with fewer cases affecting the aortic arch (12.9 vs 14.0%; P = 0.75). Operative data, including cardiopulmonary bypass and aortic cross-clamp time, concomitant aortic valve procedures and arch replacement were also similar between cohorts. Fewer elderly patients underwent hypothermic circulatory arrest (67.7 vs 90.7%, P = 0.002). Overall survival to discharge was 87.2% (n = 102), with no difference in the elderly (83.9%; n = 26) vs controls (88.4%; n = 76; P = 0.52). The 30-day (elderly: 82.8 vs controls: 86.2%), 90-day (elderly: 79.0 vs controls: 84.8%) and 1-year (elderly: 75.4 vs controls: 84.8%) survivals were also comparable.
  
  
  CONCLUSIONS
  Excellent operative outcomes can be achieved in elderly patients undergoing emergent repair of Type A aortic dissections. Advanced patient age should therefore not serve as an absolute contraindication to operative repair in this high-risk cohort.
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, The Ohio State University, Wexner Medical Center, Columbus, OH 43210, USA. ahmet.kilic@osumc.edu
authors.forename: Ahmet
authors.initials: A
authors.lastname: Kilic
authors.forename: Richard
authors.initials: R
authors.lastname: Tang
authors.forename: Bryan A
authors.initials: BA
authors.lastname: Whitson
authors.forename: John H
authors.initials: JH
authors.lastname: Sirak
authors.forename: Chittoor B
authors.initials: CB
authors.lastname: Sai-Sudhakar
authors.forename: Juan
authors.initials: J
authors.lastname: Crestanello
authors.forename: Robert S D
authors.initials: RS
authors.lastname: Higgins
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*; D016009:Chi-Square Distribution; D004630:Emergencies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009820:Ohio; D018579:Patient Selection; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality
keywords: Aortic dissection; Elderly; Great vessels
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