Ann Thorac Surg 2005;80:385
© 2005 The Society of Thoracic Surgeons
Correspondence
Reply
Bruno Chiappini, MD
Department of Cardiovascular Surgery, University of Bologna, Policlinico S. Orsola-Malpighi, Via Massarenti 9, Bologna, 40138 Italy
(Email: bruno_chiappini{at}hotmail.com).
To the Editor:
We read with interest the comments of Drs Neri and Massetti regarding our article [1]. They should be congratulated for their constructive critique. We agree that age was not used as a continuous variable in our analysis and that it was not specified how the age distribution for each patient group was in detail. To clarify the age distribution, 245 patients (77.7%) were younger than 70 years of age and 70 patients (22.3%) were 70 years of age or older, with 30% of these patients who were older than 75 years of age. The adjective "prohibitive" can have different interpretations. We wanted to clarify this based on our results that mortality in the older patient group compared favorably with the younger group, and as such we do not want to deny surgery for older patients. Of course we agree that each surgical indication has to be well-founded, taking into account several factors (certainly not only age). We all know that some octogenarians are more physically fit and healthier than some patients in their 70s. Selection is indeed an important element in every analysis concerning surgical results. Patients having an acute type A aortic dissection who were older than 80 or 90 years of age, and who were not referred to our hospital, can no longer be traced, but we do know for sure that no single patient was denied surgery only because of age. However, if an 87-year-old woman is admitted to the hospital with the diagnosis of an acute type A aortic dissection and malperfusion of the guts and or brain, we believe that even surgeons who believe that excellent results can be obtained at higher age groups will deny surgery on this patient. There is no reason to believe that this kind of serious preoperative complications should not be distributed evenly in every age group, so there is no reason to suspect that selection plays an important role in this retrospective analysis. We agree with Drs Neri and Massetti that for patients who are greater than 80 years of age, very careful consideration to perform surgery is mandatory, but simply trying to control results by including a stringent access policy goes too far for us.
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References
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- Chiappini B, Tan ME, Morshuis W, Kelder H, Dossche K, Schepens M. Surgery for acute type A aortic dissectionis advanced age a contraindication?. Ann Thorac Surg 2004;78:585-590.[Abstract/Free Full Text]
Related Article
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Acute Type A Dissection and Advanced Age
- Eugenio Neri and Massimo Massetti
Ann. Thorac. Surg. 2005 80: 384-385.
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