title: Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians.
abstract: The number of older patients with acute aortic dissection type A (AAD [A]) is increasing as the population ages. We evaluated clinical outcomes for octogenarians with AAD (A) treated surgically at our hospital. Whenever possible, we limited the replacement site of the ascending aorta to the supracoronary and hemiarch.
  
  
  
  Of 436 patients with AAD (A) seen in our hospital emergency room between April 2001 and August 2015, 90 were octogenarians. Surgery was performed using a simple cardiopulmonary bypass established through the right femoral artery and venous cannulation, and distal anastomosis was performed under deep hypothermic circulatory arrest at 20°C.
  
  
  
  Of the 90 octogenarians with AAD (A), 11 required cardiopulmonary resuscitation, 9 of whom died. Four patients with stable hemodynamics refused surgery. Thus, 77 were treated surgically. Of these 77 patients, isolated replacement of the ascending aorta or hemiarch was performed in 73 (94.8%), and total arch replacement in 4 (5.2%). Five patients (6.5%) died within 30 days, and 5 (6.5%) died in the hospital more than 30 days after surgery. Seven (9.1%) had a new stroke, 5 (6.5%) had pneumonia, and 4 (5.2%) had mediastinitis. Forty-four (57.1%) patients were discharged to their homes and 23 (30%) to rehabilitation hospitals. Three patients later required endovascular stent graft repair, which was successful in each case. The overall postoperative survival was 82%, 70%, and 62% at 1, 3, and 5 years, respectively.
  
  
  
  Our results suggest that our limited replacement protocol for emergency AAD (A) surgery has early and midterm survival benefits for octogenarians.
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan. Electronic address: haruhk@wa3.so-net.ne.jp.
authors.forename: Haruhiko
authors.initials: H
authors.lastname: Kondoh
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan.
authors.forename: Hisashi
authors.initials: H
authors.lastname: Satoh
authors.affiliation: Department of Biostatistics, Hyogo College of Medicine, Mukogawa-cho, Nishinomiya, Hyogo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Daimon
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan.
authors.forename: Yuuya
authors.initials: Y
authors.lastname: Tauchi
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan.
authors.forename: Jumpei
authors.initials: J
authors.lastname: Yamamoto
authors.affiliation: Department of Anesthesiology, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Abe
authors.affiliation: Department of Cardiovascular Surgery, Higashi Takarazuka Satoh Hospital, Nagao-cho, Takarazuka, Hyogo, Japan.
authors.forename: Hikaru
authors.initials: H
authors.lastname: Matsuda
mesh_terms: D000367:Age Factors; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001807:Blood Vessel Prosthesis; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011183:Postoperative Complications / Q000401:mortality / Q000601:surgery; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: aortic dissection; octogenarian; proximal aortic replacement