title: Acute type A dissection in octogenarians: does emergency surgery impact in-hospital outcome or long-term survival?
abstract: Surgical therapy for acute aortic dissection type A (AADA) in octogenarians carries high morbidity and mortality. The role of isolated medical treatment in this setting is controversial. The aim of this study is to determine whether risk of surgery for AADA outweighs risk of death from medical treatment only.
  
  
  
  From 2002 to 2015, 90 consecutive octogenarians (mean age, 83.5 ± 3 years) were treated for AADA at three institutions: 67 patients underwent surgery, 23 patients received medical treatment. Analysis of early and late outcome was performed.
  
  
  
  Patients in the medical treatment group were significantly older than in the surgical group (84.9 ± 3.7 vs 83 ± 2.5 years, P  = 0.008) and in a more critical state. In patients undergoing surgical repair, perioperative mortality was 14.9% ( n  = 10). Rate of prolonged ventilation (63.2% vs 5.9%; P  < 0.001) and renal failure (35.1% vs 5.9%, P  = 0.029) was significantly higher in the surgical group. Thirty-day survival was impaired in the medical treatment group (34.8% vs 61.2% in the surgical group; P  = 0.032). Coronary artery disease (OR 3.95, 95% CI 1.16-13.49; P  = 0.029) and complicated dissections (OR 5.28, 95% CI 1.48-18.88; P  = 0.010)-composite variable of preoperative resuscitation, neurological injury and malperfusion-emerged as independent risk factors for 30-day mortality in the surgical group. There was no difference in long-term survival.
  
  
  
  Emergency surgery for AADA in octogenarians is associated with relatively high intraoperative mortality and may reasonably be avoided in patient with complicated presentation. Despite better immediate survival after surgery, long-term survival does not differ between medical and surgical patients, reflecting the extremely advanced point in life cycle octogenarians.
authors.affiliation: University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.|Aortic Institute Yale New Haven, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Julia
authors.initials: J
authors.lastname: Dumfarth
authors.affiliation: Aortic Institute Yale New Haven, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Sven
authors.initials: S
authors.lastname: Peterss
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Luehr
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
authors.forename: Christian D
authors.initials: CD
authors.lastname: Etz
authors.affiliation: University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Schachner
authors.affiliation: University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Markus
authors.initials: M
authors.lastname: Kofler
authors.affiliation: Aortic Institute Yale New Haven, Yale School of Medicine, New Haven, CT, USA.|Kazan State Medical University, Kazan, Russia.
authors.forename: Bulat A
authors.initials: BA
authors.lastname: Ziganshin
authors.affiliation: Department of Medical Statistics, Informatics and Health Economics, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.affiliation: University Clinic for Cardiac Surgery, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.affiliation: Aortic Institute Yale New Haven, Yale School of Medicine, New Haven, CT, USA.
authors.forename: John A
authors.initials: JA
authors.lastname: Elefteriades
authors.affiliation: Department of Cardiac Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
authors.forename: Friedrich W
authors.initials: FW
authors.lastname: Mohr
mesh_terms: D000208:Acute Disease; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000188:drug therapy / Q000401:mortality / Q000601:surgery*; D001317:Austria / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D004630:Emergencies; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Medical treatment ; Octogenarians ; Surgery ; Survival benefit; Type A aortic dissection 