title: Acute type A aortic dissection repair in elderly patients.
abstract: OBJECTIVE
  We evaluated our experience in acute type A aortic dissection (ATAAD) repair in elderly patients. The role of clinical presentation and surgical strategies in determining patients' outcome was further assessed.
  
  
  METHODS
  A retrospective analysis of patients over 75 years who underwent emergency repair of ATAAD at our institution during 2000-13 was performed. Forty-five patients (mean age = 79 ± 3 years; 26 females) were identified. Aortic dissection was complicated in 17 (37%) patients with new neurological deficit (n = 5), cardiac tamponade (n = 12), acute myocardial infarction (n = 5) and acute renal failure (n = 2). The ascending aorta was replaced in all patients and hypothermic circulatory arrest was employed in 22 patients. The aortic replacement needed extension to the hemiarch in 11 patients and the aortic valve was replaced in 9 patients; in 3 cases, full root replacement was performed.
  
  
  RESULTS
  The in-hospital mortality rate was 15% (n = 7). Preoperative acute neurological deficit was the only independent risk factor for mortality (P = 0.03). Age >80 years old per se was not associated with a poor outcome. Surgical strategies and extension of aortic wall resection did not affect the operative mortality. The postoperative course was complicated in 23 (52%) patients. During the median follow-up of 57 months, there were 4 late deaths. The cumulative 1-, 5- and 8-year survival rates were 82, 76 and 67%, respectively.
  
  
  CONCLUSIONS
  Emergency surgical repair of ATAAD in elderly patients resulted in an acceptable early mortality rate and satisfactory intermediate survival. Preoperative acute neurological deficit predicts a worse outcome. Advanced age alone should not be considered as a contraindication to AAD repair.
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK pmalvin@tin.it.
authors.forename: Pietro G
authors.initials: PG
authors.lastname: Malvindi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Amit
authors.initials: A
authors.lastname: Modi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Szabolcs
authors.initials: S
authors.lastname: Miskolczi
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Markku
authors.initials: M
authors.lastname: Kaarne
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Clifford
authors.initials: C
authors.lastname: Barlow
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Ohri
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Steven
authors.initials: S
authors.lastname: Livesey
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Geoffrey
authors.initials: G
authors.lastname: Tsang
authors.affiliation: Wessex Cardiothoracic Centre, Southampton University Hospital NHS Trust, Southampton, UK.
authors.forename: Theodore
authors.initials: T
authors.lastname: Velissaris
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000453:epidemiology / Q000401:mortality* / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D016896:Treatment Outcome
keywords: Aorta/aortic; Aortic dissection; Aortic operation; Geriatric