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Original Articles: Adult Cardiac

Outcomes After Surgical Treatment for Type A Acute Aortic Dissection in Octogenarians: A Multicenter Study

^a "Amiens Picardie" University Hospital, Amiens, France
^b "San Martino" University Hospital, Genova, Italy
^c "Henri Mondor" University Hospital, Creteil, France
^d "La Timone" University Hospital, Marseille, France
^e "Arnault Tzank" Institut, St. Laurent du Var, France

Accepted for publication April 24, 2009.

^_* Address correspondence to Dr Piccardo, Service de Chirurgie Cardiaque, CHU Amiens-Picardie, Avenue René Laennec, Amiens, 80054, France (Email: piccardo.alessandro{at}chu-amiens.fr).

Presented at the Poster Session of the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: Management of octogenarian patients with acute type A acute aortic dissection is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.

Methods: Beginning January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 57 consecutive patients enrolled up to December 2006. Their median age was 82 (range, 80 to 89 years). Compassionate indication operations were attempted in 2 moribund patients and in 5 presenting with shock associated with neurologic symptoms or renal failure, or both. Operations followed the standard procedure recommended in younger patients. Follow-up was 100% complete (mean, 3.9 ± 2 years; range, 5 months to 8 years).

Results: There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication (p 0.0001) and total arch replacement (p = 0.0060) as risk factors for in-hospital mortality. Postoperative complications occurred in 36 patients (69.2%) and were associated with a higher mortality (p = 0.0001). Overall survival was 51% at 1 year and 44% at 5 years. Excluding patients with compassionate indication and those who underwent total arch replacement, or both, overall survival was 66% at 1 year and 57% at 5 years.

Conclusions: Surgical treatment for type A acute aortic dissection in octogenarians shows satisfactory midterm results among survivors. However, the high mortality rate imposes a requirement for better perioperative management. Compassionate cases should be managed medically. A less aggressive approach should improve outcomes of surgical treatment.