Impact of Hemodynamic Instability and Organ Malperfusion in Elderly Surgical Patients Treated for Acute Type A Aortic Dissection.
OBJECTIVE
Recent studies indicate acceptable survival rates in elderly patients treated surgically for acute type A aortic dissection (aTAAD). However, the impact of preoperative hemodynamic compromise or organ malperfusion on outcomes of such patients is still unclear.


METHODS
In a retrospective study of 341 patients, 101 qualified as elderly (≥70 years old). Subjects were further grouped by clinical presentation, using the Penn classification. Univariate and multivariable analyses were conducted to identify variables reflecting in-hospital and long-term mortality.


RESULTS
Relative to younger subjects, elderly patients showed significantly higher rates of in-hospital mortality (24.8% vs. 14.6%, p = 0.025) and DeBakey type 2 dissections at presentation (40% vs. 18% p < 0.001), with significantly fewer presenting as Penn class Ab (p = 0.010). Penn class Ac was identified as an independent predictor of in-hospital mortality at all ages. Estimated long-term survival was poorer in the elderly (log rank p < 0.001); but in-hospital mortality, based on Penn classification, was similar for both age groups. Survival rates of Penn class Aa subjects at one, five, and 10 years were lower in elderly (vs. younger) patients (79 ± 5.6% vs. 90 ± 2.7%, 68 ± 6.7% vs. 80 ± 3.9%, and 39 ± 10.3% vs. 75 ± 4.6%, respectively; log rank p < 0.001).


CONCLUSIONS
Overall in-hospital mortality is higher in elderly patients surgically treated for aTAAD. Malperfusion and/or hemodynamic instability at presentation confer a dismal prognosis, independent of patient age.
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Igor
I
Zindovic
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Johan
J
Sjögren
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Henrik
H
Bjursten
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Eric
E
Danielsson
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Richard
R
Ingemansson
Department of Cardiothoracic Surgery, Skane University Hospital, Lund University, Lund, Sweden.|Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Lund, Sweden.
Shahab
S
Nozohoor
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000145:classification / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000145:classification / Q000401:mortality / Q000503:physiopathology* / Q000601:surgery*; D001775:Blood Circulation; D005260:Female; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome