title: Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation.
abstract: BACKGROUND
  The management of acute type A aortic dissection (aTAAD) in octogenarian patients is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.
  
  
  METHODS
  Beginning in January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 79 consecutive patients enrolled up to December 2010. Their median age was 81.6 years (range, 80 to 89 years). Sixteen patients (20%) presented a complicated type because of a neurologic deficit, mesenteric ischemia, a requirement for cardiopulmonary resuscitation, or some combination of those features. Operations followed the standard procedure recommended for younger patients. Follow-up was 95% complete (mean, 4.6±2.8 years).
  
  
  RESULTS
  The overall in-hospital mortality was 44.3%. The in-hospital mortality among patients with uncomplicated aTAAD was 33.3%. Multivariate analysis identified complicated aTAAD as the only risk factors for in-hospital mortality (p<0.0001). Postoperative complications occurred in 50 patients (68.5%) and were associated with a higher mortality (p<0.0001). The overall survival was 53% at 1 year and 32% at 5 years. In uncomplicated aTAAD, the overall survival was 63% at 1 year and 38% at 5 years.
  
  
  CONCLUSIONS
  Octogenarians with uncomplicated aTAAD benefit from emergency surgical repair. In those patients, early and midterm outcomes are good and are similar to those in published series of younger patients. Complicated aTAAD should be medically managed.
authors.affiliation: Dupuytren University Hospital, Limoges, France. alessandropiccardo@gmail.com
authors.forename: Alessandro
authors.initials: A
authors.lastname: Piccardo
authors.forename: Alexandre
authors.initials: A
authors.lastname: Le Guyader
authors.forename: Tommaso
authors.initials: T
authors.lastname: Regesta
authors.forename: Vlad
authors.initials: V
authors.lastname: Gariboldi
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Zannis
authors.forename: Michel
authors.initials: M
authors.lastname: Tapia
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.forename: Matthias
authors.initials: M
authors.lastname: Kirsch
authors.forename: Thierry
authors.initials: T
authors.lastname: Caus
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Cornu
authors.forename: Marc
authors.initials: M
authors.lastname: Laskar
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods* / Q000401:mortality; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D017741:Survivors / Q000706:statistics & numerical data; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography
keywords: 26