title: Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults.
abstract: Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients.
  
  
  
  We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n  = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n  = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery.
  
  
  
  The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P  = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P  = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P  = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P  = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P  = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P  = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P  = 0.12).
  
  
  
  Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jill
authors.initials: J
authors.lastname: Jussli-Melchers
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Bernd
authors.initials: B
authors.lastname: Panholzer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Friedrich
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Ole
authors.initials: O
authors.lastname: Broch
authors.affiliation: Department of Anesthesiology and Intensive Care Medicine, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Renner
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Schöttler
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Aziz
authors.initials: A
authors.lastname: Rahimi
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Cremer
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Schoeneich
authors.affiliation: Department of Cardiovascular Surgery, University of Schleswig-Holstein, Campus Kiel, Kiel, Germany.
authors.forename: Assad
authors.initials: A
authors.lastname: Haneya
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000534:rehabilitation / Q000601:surgery*; D001014:Aortic Aneurysm / Q000534:rehabilitation / Q000601:surgery*; D004630:Emergencies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011594:Psychometrics; D011788:Quality of Life; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000379:methods / Q000534:rehabilitation; D055815:Young Adult
keywords: Acute aortic dissection type A ; Elderly ; Quality of life