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ORIGINAL ARTICLE
Chirurgia 2018 June;31(3):79-84
DOI: 10.23736/S0394-9508.17.04606-X
Copyright © 2017 EDIZIONI MINERVA MEDICA
language: English
Surgical outcomes for type-A aortic dissection in septuagenarians and octogenarians
Nikola DOBRILOVIC 1 ✉, James G. FINGLETON 1, Jason MACHAN 2, Lidia A. VOGNAR 3, William FENG 1, Michael A. COADY 1, Jun FENG 1, Paula CASEY 1, Arun K. SINGH 1
1 Division of Cardiothoracic Surgery, Alpert Medical School of Brown University, Providence, RI, USA; 2 Department of Surgery, Alpert Medical School of Brown University, Providence, RI, USA; 3 Division of Geriatrics and Palliative Medicine, Department of Medicine, Alpert Medical School of Brown University, Providence, RI, USA
BACKGROUND: Surgery for acute type-A aortic dissection (TAAD) in the elderly is associated with high morbidity and mortality. These older patients are often denied surgery. The natural history of TAAD is extremely poor without surgical treatment. We reviewed our surgical experience among patients 70 years of age and older.
METHODS: A retrospective review of consecutive patients was conducted from 1996 to 2010 of patients 70 years of age and older that underwent surgery for TAAD. Multiple logistic regression was used to test for predictors of operative mortality. Long-term survival was tracked and evaluated using Kaplan-Meier survival analysis.
RESULTS: Sixty-seven patients met inclusion criteria. Average age was 77±4.6. Twenty-two (33%) patients were 80 years of age or older. Operative mortality was 21% (14/67) overall, 18% (8/45) for septuagenarians, and 27% (6/22) for octogenarians. There was evidence of an interaction between ejection fraction (EF) and patient age that approached statistical significance.
CONCLUSIONS: Data suggest that satisfactory outcomes can be achieved for septuagenarian and octogenarian patients requiring surgical treatment for TAAD. In elderly patients treated surgically for TAAD, EF predicted mortality in the younger portion of this (elderly) group. This trend diminished as age increased.
KEY WORDS: Aorta - Dissection - Patient outcome assessment - Aged, 80 and over