HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Motomi Shiono Mitsumasa Hata Akira Sezai Nanao Negishi Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Shiono, M. Articles by Negishi, N. Search for Related Content PubMed PubMed Citation Articles by Shiono, M. Articles by Negishi, N. Related Collections Great vessels

Ann Thorac Surg 2006;82:554-559
© 2006 The Society of Thoracic Surgeons

---

Original article: Cardiovascular

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians

Department of Cardiovascular Surgery, Nihon University School of Medicine, Tokyo, Japan

Accepted for publication December 13, 2005.

^_* Address correspondence to Dr Shiono, Department of Cardiovascular Surgery, Nihon University School of Medicine, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo 173-8610, Japan (Email: mshiono{at}med.nihon-u.ac.jp).

BACKGROUND: Emergency surgery for acute type A dissection is associated with a high mortality rate in aged patients. This study was designed to explore perioperative risk factors and prognosis in octogenarians with acute type A aortic dissection.

METHODS: Twenty-four octogenarians, of 134 consecutive patients with acute type A dissection between 1995 and 2005 who underwent emergency surgery, were reviewed. The median age was 82 years (80 to 90); the patients were 10 men and 14 women. All 24 patients underwent conservative tear-oriented surgery under deep hypothermic circulatory arrest with cerebral perfusion; the procedures were 23 ascending aortic replacements and one entire arch replacement.

RESULTS: The hospital mortality rate was 13% (3 of 24 patients), without statistical significance compared with 6% in patients younger than 80 years. The late mortality rate was 38% (9 of 24 patients), with significance compared with 9% in the other patients. Five- and 10-year survivals ware 55% and 42%, respectively, compared with 83% and 73%, respectively (p = 0.0013), in the other patients. Univariate and multivariate analysis demonstrated that age 80 or greater was not an independent risk factor of hospital death. Risk factors of late death in younger-aged patients were pneumonia and reoperation.

CONCLUSIONS: Emergency surgery for octogenarians with acute type A aortic dissection was successfully performed using a conservative intimal tear-oriented procedure, resulting in satisfactory early and late survival. Aggressive surgical treatment is mandatory for improving the outcome of this medical emergency in octogenarians.

This article has been cited by other articles:

				J. Babin-Ebell and M. Misfeld Medical Treatment for Acute Type A Aortic Dissection? Ann. Thorac. Surg., March 1, 2008; 85(3): 1139 - 1140. [Full Text] [PDF]

				M. Shrestha, N. Khaladj, A. Haverich, and C. Hagl Is Treatment of Acute Type A Aortic Dissection in Septuagenarians Justifiable? Asian Cardiovasc Thorac Ann, February 1, 2008; 16(1): 33 - 36. [Abstract] [Full Text] [PDF]