Ascending aortic replacement for acute type A aortic dissection in octogenarians

Abstract

The management of acute type A aortic dissection in elderly patients is controversial. This study aimed to investigate the validity of ascending aortic replacement for acute type A aortic dissection in octogenarians compared with younger patients. Twenty-five octogenarians, among 117 consecutive patients with acute type A aortic dissection between January 2000 and October 2013 who underwent emergency surgery, were reviewed retrospectively. The median age was 84 years (80-91 years). The patients were six men and 19 women. All 25 patients underwent ascending aortic replacement under deep hypothermic circulatory arrest. In the same period, 55 patients younger than 80 years with acute type A aortic dissection had ascending aortic replacement performed. Clinical data were prospectively entered into our institutional database. Late follow-up was 6.8 ± 2.8 years and was 100% complete. The 30-day mortality rate was 8% (2/25 patients), which was similar to that in patients younger than 80 years (5%). There were no reoperations in octogenarians and five reoperations in younger patients in the follow-up period. Survival at 1 and 5 years was 80.0 and 59.7% in octogenarians and 90.6 and 81.9% in younger patients, respectively (P = 0.036). Ascending aortic replacement for octogenarians with acute type A aortic dissection was successfully performed, resulting in satisfactory early and midterm survival. Aggressive surgical treatment is mandatory for improving the outcome in octogenarians with acute type A aortic dissection.