NYMC Faculty Publications

Surgery for Acute Type A Aortic Dissection in Octogenarians is Justified

Author Type(s)

Faculty

DOI

10.1016/j.jtcvs.2012.11.060

Journal Title

The Journal of Thoracic and Cardiovascular Surgery

First Page

186

Last Page

190

Document Type

Article

Publication Date

3-1-2013

Department

Surgery

Keywords

Acute Disease, Adult, Age Factors, Aged, Aged, 80 and over, Aortic Dissection, Aortic Aneurysm, Blood Vessel Prosthesis Implantation, Circulatory Arrest, Deep Hypothermia Induced, Emotions, Female, Hospital Mortality, Humans, Kaplan-Meier Estimate, Male, Middle Aged, New York, Patient Selection, Quality of Life, Retrospective Studies, Risk Factors, Surveys and Questionnaires, Time Factors, Treatment Outcome

Disciplines

Medicine and Health Sciences

Abstract

OBJECTIVE: Surgery in octogenarians with acute type A aortic dissection is commonly avoided or denied because of the high surgical morbidity and mortality reported in elderly patients. We sought to compare clinical and quality of life outcomes between octogenarians and those aged less than 80 years who underwent surgical repair at New York Medical College.

METHODS: A total of 101 cases of acute type A aortic dissection repair between July 2005 and December 2011 were retrospectively analyzed, comparing 21 octogenarians with 80 concurrent patients aged less than 80 years. All patients underwent corrective surgery (ascending/hemiarch replacement in 71; Bentall in 22; David procedure in 2; Wheat procedure in 4; total arch replacement in 2) using deep hypothermic circulatory arrest. During follow-up, the RAND 36-Item Short Form Health Survey Questionnaire was used to assess quality of life.

RESULTS: Octogenarians (average, 85 years; range, 80-91 years) were compared with the younger group (average, 60 years; range, 30-79 years). The 2 groups had similar preoperative characteristics, but the younger group experienced more malperfusion (40% vs 9%, P = .002), were more likely to have undergone a Bentall procedure (26% vs 5%, P = .04), and had longer circulatory arrest times (20 ± 7 minutes vs 16 ± 9 minutes, P = .03). The overall hospital mortality was 9% (9/101). Among octogenarians, there were no hospital deaths, no late deaths during follow-up (mean, 17 months; range, 1-59 months), and emotional health scores were better than those of the younger patients (P = .04).

CONCLUSIONS: Surgery for acute type A aortic dissection should be offered to octogenarians because excellent surgical and quality of life outcomes can be achieved even in this elderly population.

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