Dissection In Octogenarians Research Articles

Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians.

To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection. We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups. The median age was 84years (interquartile range 82-87years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97cm2/m2. Except for sex, no significant differences were observed in patients' baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015). All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85years or older.

Early mortality of emergency surgery for acute type A aortic dissection in octogenarians and nonagenarians: A multi-center retrospective study

ObjectivesThe clinical data on postoperative mortality and central nervous system (CNS) complications in older adults who underwent acute type A aortic dissection are limited. Thus, in this study we aimed to evaluate the association between age and early postoperative mortality and occurrence of CNS complications. MethodsThis multicentric retrospective cohort study included 5 tertiary hospitals in Japan. All patients who underwent emergency surgery for acute type A aortic dissection between October 1998 and December 2019 were enrolled. The multilevel Cox proportional hazards model, which considered years as level 1, institutions as level 2, and surgeons as level 3, was used to evaluate the association between age and early postoperative hospital mortality and occurrence of CNS complications. ResultsOf the 1037 patients, 227 (21.9%) were ≥80 years old and 810 (78.1%) were <80 years old. Overall, 134 patients (12.9%) died within 30 days postoperatively; among them, 42/227 (18.5%) and 92/810 (11.4%) were aged ≥80 and <80 years, respectively (hazard ratio [HR], 1.63; P = .0046). CNS complications within 30 days postoperatively occurred in 140/1037 (13.5%) patients; among them, 42/227 (18.5%) and 98/810 (12.1%) were aged ≥80 and <80 years, respectively (HR, 1.63; P = .011). In multivariate analysis, age ≥80 years was associated with mortality within 30 days postoperatively (adjusted HR, 2.37; 95% CI, 1.23-4.57; P = .01) but not with CNS complications (adjusted HR, 1.58; 95% CI, 0.93-2.69; P = .091). ConclusionsThe early postoperative mortality in older patients was approximately 50% higher than in the younger population. A thorough discussion regarding the surgical indications should be done.

Emergency surgery for type A aortic dissection in octogenarians-Do we still err on the side of caution?

Emergency surgery for type A aortic dissection in octogenarians-Do we still err on the side of caution?

Outcome of emergency surgery for acute type A aortic dissection in octogenarians.

Emergency surgery for acute type A aortic dissection (AAAD) was usually avoided or denied in octogenarians because of high surgical mortality. Refined surgical techniques and improved postoperative care have led to an improved in-hospital outcome. However, a significant number of operative survivors suffered from postoperative complications and had compromised quality of life. We sought to assess the clinical outcome of emergency surgery using a standard conservative approach in octogenarians with AAAD. From 2004 to 2021, 123 patients underwent emergency surgery for AAAD by one surgeon using a standard conservative approach with right subclavian artery cannulation, no aortic cross-clamp, selective antegrade cerebral perfusion, moderate systemic hypothermia, reinforced sandwich technique, and a strategy of limited aortic resection. Hospital and late outcomes were assessed in patients with age >80 years. Eighteen patients (15%) were octogenarians with seven males (39%) and median age of 82 years (range, 80-89). Hypertension was present in six patients (33%). None had diabetes mellitus, Marfan, or bicuspid aortic valve. Dissection was intramural hematoma in six (33%) and DeBakey type I in 15 patients (83%). Cardiac tamponade with shock was present in seven patients (39%). Ascending aortic grafting was performed in 17 patients, and additional hemiarch replacement in one patient. The hospital mortality rate was 17% (3/18). Fourteen patients (82%) were alive and well at discharge. Emergency surgery for AAAD using a standard conservative approach showed an improved outcome in octogenarians. The majority of patients could return home with an acceptable living.

The results of an entry-oriented strategy for acute type A aortic dissection in octogenarians: an 18-year experience.

The aim of this study was to evaluate the 18-year results of emergency operations for acute type A aortic dissection, especially in octogenarians. We reviewed 199 patients who underwent surgical aortic repair of an acute type A aortic dissection from January 2001 to December 2018. If the primary entry existed in the ascending aorta, we limited the extent of the replacement to within the ascending aorta. We analysed the early and late outcomes and identified the predictive factors for in-hospital death and difficulty of direct discharge to home. The hospital mortality was 16%. The causes of death were postoperative bleeding (n = 8, 4%), intestinal ischaemia (n = 6, 3%), respiratory failure (n = 5, 3%), systemic inflammatory response syndrome (n = 4, 2%), low output syndrome (n = 3, 2%), sudden death (n = 3, 2%), myonephrotic metabolic syndrome (n = 2, 1%) and stroke (n = 1, 1%). Multivariable analysis revealed that an estimated glomerular filtration rate <30 (P = 0.006), malperfusion (P = 0.001), rupture (P < 0.001) and cross-clamping time (P = 0.003) were independent predictive factors of in-hospital death. Age was not a significant factor for predicting in-hospital death. Ascending aorta replacement (P = 0.013), advanced age (P = 0.002) and prolonged extracorporeal circulation time (P = 0.009) were independent predictive factors of difficulty in direct discharge to home. In the late follow-up period, the 5-year survival and aortic event-free rates were 62.2% and 88.9% in octogenarians, respectively. From the perspective of saving lives, the results of emergency surgery for octogenarians were acceptable. Avoiding the postoperative decline in activities of daily living in octogenarians is a consideration going forward.

Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians

ObjectiveThe incidence of elderly patients with acute type A aortic dissection is increasing. A recent analysis of the International Registry of Acute Aortic Dissection failed to show a mortality benefit with surgery compared with medical management in octogenarians. Therefore, we compared our institutional outcomes of emergency surgery for acute type A aortic dissection in octogenarians versus septuagenarians to understand the outcomes of surgical intervention in elderly patients. MethodsFrom 2002 to 2017, 70 octogenarians (aged ≥80 years) and 165 septuagenarians (70-79 years) underwent surgery for acute type A aortic dissection (N = 235, total). Quality of life was assessed by the RAND Short Form-36 quality of life survey. Midterm clinical and functional data were obtained retrospectively. ResultsAt baseline, septuagenarians had a higher prevalence of diabetes (20.6% vs 5.7%, P = .01). The prevalence of cardiopulmonary resuscitation was 4.8% versus 10.0% (P = .24) in septuagenarians and octogenarians. The prevalence of cardiogenic shock was 18.2% versus 27.1% (P = .17). Thirty-day/in-hospital mortality was 21.2% versus 28.6% (P = .29). Multivariable logistic regression identified cardiogenic shock as an independent risk factor for in-hospital mortality (odds ratio, 10.07; 95% confidence interval, 2.30-44.03) in octogenarians. Survival at 5 years was 49.7% (42.1%-58.6%) versus 34.2% (23.9%-48.8%) in septuagenarians and octogenarians, respectively. Responses to the quality of life survey were no different between septuagenarians and octogenarians across all 8 quality of life categories. ConclusionsClinical outcomes after surgery for acute type A aortic dissection are similar in octogenarians and septuagenarians. For discharged survivors, quality of life remains favorable and does not differ between the 2 groups.

P5600Surgical reconstruction of type A aortic dissection in octogenarians

Abstract Introduction Because the population is aging, the indication for surgical reconstruction in older patients will increase. Japan is especially facing the most aging society worldwide. However, surgical reconstruction of type A aortic dissection (AADA) in patients who are octogenarians is not often performed because of the decision of the patient or surgeon. We examined the outcome of surgical reconstruction of AADA in octogenarians. Method Over 4 years, 132 cases of surgical reconstruction of AADA were analyzed. Twenty-five consecutive octogenarians with AADA were retrospectively reviewed. In our institution, we recommend an emergent operation to the patient or family in all generations unless they reject it for some reason. Results Operative factors in octogenarians with AADA were not significantly different compared with those in patients aged younger than 79 years (n=107) (operation: 238±11 vs. 246±5 min, p=0.54; cardiopulmonary bypass: 147±7.4 vs. 154±3.5 min, p=0.42; aortic-clamp: 114±6.0 vs. 120±2.8 min, p=0.36; hypothermic-arrest: 43±2.7 vs. 42±1.3 min, p=0.81). The overall mortality rate was 24.0% (n=6). The mortality rate was no difference between younger patients and octogenarians (OR: 2.7, 95% CI: 0.86–8.21, p=0.08). Furthermore, MACE (Major Adverse Cardiac Event) and the postoperative stroke rate were not significantly different between the two groups (OR: 1.5, 95% CI: 0.52–3.93, p=0.42; OR: 0.77, 95% CI: 0.16–2.59, p=0.69, respectively). Conclusion In AADA, the outcome of emergent surgical reconstruction in octogenarians is acceptable. Even with the risk of aging, surgeons should consider aggressive surgical reconstruction in octogenarians.

How should we treat uncomplicated subacute type B aortic dissection in octogenarians?

BackgroundPreemptive thoracic endovascular aortic repair (TEVAR) is an advanced treatment that has possibility to improve late outcomes in patients with subacute type B aortic dissection. However, it may not be the treatment of choice for elderly patients with uncomplicated subacute type B aortic dissection because of their inherent frailty and increased risk of periprocedural complications.MethodsData were collected between July 2004 and October 2017 in Yamagata university hospital and between February 2016 and May 2018 in Nihonkai General hospital. A total of 152 medically treated subacute type B aortic dissection patients were enrolled in this study. Patients were divided into two groups: age 80 year and older group (Group O, n = 33, 22%) and a group < 80 years of age (Group U, n = 119, 78%).ResultsDuring follow-up, the incidence of adverse events was 27% (n = 9) in Group O and 37% (n = 44) in Group U (P = 0.409). The incidence of aortic rupture was 3% (n = 1), and the incidence of acute type A dissection was 3% (n = 1) in Group O. In Group O, only one patient (3%) died of aorto-bronchial fistula. The Group O patients had less surgical intervention (3 patients [9%] in Group O and 30 patients [25%] in Group U, P = 0.047), but aortic related death did not differ between the two groups. The 1-, 2-, and 5-year freedom from aorta-related death rates of Group O were 97, 97, and 97%, respectively, compared with 99, 94, and 91%, respectively, in Group U (P = 0.880).ConclusionsPatients aged 80 years and older who underwent medical treatment for acute and subacute type B dissection had excellent outcomes in chronic phase. The elderly patients had less surgical intervention, but aortic related death did not differ from younger patients.

Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Octogenarians are often declined an emergency operation for acute type A aortic dissection on grounds of high mortality rate and short life expectancy. Our policy is to accept all patients at any time and never to refuse an emergency operation, even for octogenarians. From April 2004 to September 2017, 319 patients underwent surgical repair for acute type A aortic dissection at our institution. We compared the clinical results between the 55 elderly patients (≥80 years old; older group) and the 264 nonelderly patients (≤79 years old; younger group). The primary end point was early mortality, and the secondary end point was long-term mortality. The older group had a higher proportion ofwomen (74.5% vs 46.6%), a lower body mass index (21.4 vs 23.8 kg/m2), and a lower proportion of smokers (20.0% vs 46.2%). In the two groups (older vs younger), postoperative stroke occurred in 12.7% versus 11.4% and hospital mortality in 10.2% versus 10.9%, with no significant statistical difference. In multivariate analysis, older age of 80 years or older was not a significant risk factor for hospital mortality. Among the hospital survivors, the actuarial survival rate at 8 years was 52.5% in the older group and 85.0% in the younger group (p= 0.005). Emergency surgical repair for type A aortic dissection in octogenarians without patient selection resulted in similar rates of mortality and morbidity as younger patients. Octogenarians should not be refused this life-saving emergency operation.

Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians

Although surgical outcomes of acute type A aortic dissection (ATAAD) have improved, it is still a high-risk procedure for octogenarians. This study analyzed early and late outcomes of surgical repair of ATAAD among octogenarians. From 1990 through 2016, 1,260 consecutive patients with ATAAD were emergently admitted to Jichi Medical University Hospitals. Of them, 1,026 patients who underwent emergency surgery for ATAAD within 48 hours of symptom onset were included in this retrospective study. Of these, 112 were aged 80 years or more (mean, 83.1 ± 2.7) and formed the octogenarian group; and 914 were aged less than 80 years (mean, 62.0 ± 11.4) and formed the control group. Early and late outcomes were compared. The inhospital mortality rate was 6.3% for theoctogenarian group and 7.4% for the control group(p= 0.85). No significant difference was observed in the causes of hospital death. Although the overall postoperative complication rate was not different (24.1% versus 23.0%), pneumonia was more frequent among octogenarians (p= 0.03). Multivariate analysis of hospital mortality did not indicate age 80 years or more as a risk factor. Overall postoperative survival for the octogenarian group was 84.6%, 70.5%, and 57.1% at 1, 3, and 5 years, respectively. For the control group, the rates were 89.1%, 85.6%, and 82.1%, respectively. Pneumonia and decrepitude were the major causes of remote death for the octogenarian group. No significant difference in the hospital mortality rate or the complication rate was observed between the groups. Emergency surgery for ATAAD in octogenarians could be performed with the same low risk observed for younger patients.

Acute type A dissection in octogenarians: does emergency surgery impact in-hospital outcome or long-term survival?†

Surgical therapy for acute aortic dissection type A (AADA) in octogenarians carries high morbidity and mortality. The role of isolated medical treatment in this setting is controversial. The aim of this study is to determine whether risk of surgery for AADA outweighs risk of death from medical treatment only. From 2002 to 2015, 90 consecutive octogenarians (mean age, 83.5 ± 3 years) were treated for AADA at three institutions: 67 patients underwent surgery, 23 patients received medical treatment. Analysis of early and late outcome was performed. Patients in the medical treatment group were significantly older than in the surgical group (84.9 ± 3.7 vs 83 ± 2.5 years, P = 0.008) and in a more critical state. In patients undergoing surgical repair, perioperative mortality was 14.9% ( n = 10). Rate of prolonged ventilation (63.2% vs 5.9%; P < 0.001) and renal failure (35.1% vs 5.9%, P = 0.029) was significantly higher in the surgical group. Thirty-day survival was impaired in the medical treatment group (34.8% vs 61.2% in the surgical group; P = 0.032). Coronary artery disease (OR 3.95, 95% CI 1.16-13.49; P = 0.029) and complicated dissections (OR 5.28, 95% CI 1.48-18.88; P = 0.010)-composite variable of preoperative resuscitation, neurological injury and malperfusion-emerged as independent risk factors for 30-day mortality in the surgical group. There was no difference in long-term survival. Emergency surgery for AADA in octogenarians is associated with relatively high intraoperative mortality and may reasonably be avoided in patient with complicated presentation. Despite better immediate survival after surgery, long-term survival does not differ between medical and surgical patients, reflecting the extremely advanced point in life cycle octogenarians.

Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians

ObjectiveThe number of older patients with acute aortic dissection type A (AAD [A]) is increasing as the population ages. We evaluated clinical outcomes for octogenarians with AAD (A) treated surgically at our hospital. Whenever possible, we limited the replacement site of the ascending aorta to the supracoronary and hemiarch. MethodsOf 436 patients with AAD (A) seen in our hospital emergency room between April 2001 and August 2015, 90 were octogenarians. Surgery was performed using a simple cardiopulmonary bypass established through the right femoral artery and venous cannulation, and distal anastomosis was performed under deep hypothermic circulatory arrest at 20°C. ResultsOf the 90 octogenarians with AAD (A), 11 required cardiopulmonary resuscitation, 9 of whom died. Four patients with stable hemodynamics refused surgery. Thus, 77 were treated surgically. Of these 77 patients, isolated replacement of the ascending aorta or hemiarch was performed in 73 (94.8%), and total arch replacement in 4 (5.2%). Five patients (6.5%) died within 30 days, and 5 (6.5%) died in the hospital more than 30 days after surgery. Seven (9.1%) had a new stroke, 5 (6.5%) had pneumonia, and 4 (5.2%) had mediastinitis. Forty-four (57.1%) patients were discharged to their homes and 23 (30%) to rehabilitation hospitals. Three patients later required endovascular stent graft repair, which was successful in each case. The overall postoperative survival was 82%, 70%, and 62% at 1, 3, and 5 years, respectively. ConclusionsOur results suggest that our limited replacement protocol for emergency AAD (A) surgery has early and midterm survival benefits for octogenarians.

Ascending aortic replacement for acute type A aortic dissection in octogenarians

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.

Surgical Repair for Acute Type A Aortic Dissection in Octogenarians

Despite limited data, the necessity for immediate surgical intervention in octogenarians with acute type A aortic dissection (AAD) has recently been questioned because the surgical risk may outweigh its potential benefits. At the same time, evolving stent graft technologies are pushing in the market for pathology within the ascending aorta, even for treatment of AAD. Against this background, we analyzed our institutional experience in this patient cohort during the last 8 years. Between October 2005 and October 2013, 39 patients aged older than 80 years (82 ± 2 years) underwent surgical repair for AAD, of which 29 patients (74%) were men. Owing to patient age and comorbidities, we aimed to limit the operation to supracoronary hemiarch replacement whenever possible. Clinical data were prospectively entered into our institutional database. Late follow-up was 3.6 ± 2.8 years and was 100% complete. Hemiarch replacement was performed in 32 patients (82%), and full arch replacement was necessary in the remaining 7. In 31 patients (79%), the aortic root could be glued and reconstructed or remained untouched. The remaining 8 patients (21%) underwent the bio-Bentall procedure. Mean ventilation time was 46 ± 23 hours, and the intensive care unit stay was 5 ± 9 days. We observed new postoperative permanent neurologic deficits in 2 patients (5%) and transient neurologic deficits in 3 (8%). The 30-day mortality was 26% (n = 10). Kaplan-Meier estimates for late survival were 46% ± 16% at 5 years. Given the guidelines regarding the predicted risk of death in patients with untreated AAD, current data suggest a survival benefit with immediate open surgical intervention even in octogenarians. Similarly to the early days of transcatheter-based aortic valve implantation, open surgical reference data are warranted to set the bar for upcoming endovascular treatment of AAD in octogenarians.

Surgery for acute type A aortic dissection in octogenarians: Wait and hope or hit and run?

Surgery for acute type A aortic dissection in octogenarians: Wait and hope or hit and run?

Surgery for Acute Type A Aortic Dissection in Octogenarians

Emergency surgery for type A aortic dissection (AAD) is associated with high mortality rates. The published outcomes of such surgery in aging patients are controversial and the optimal management for elderly patients has not been established. Our study aimed to evaluate the outcomes of surgery for AAD in patients over the age of 80 years. Between January 1996 and January 2010, 236 patients underwent surgery for AAD, of which 15 patients were older than 80 years. We evaluated the operative mortality in the whole cohort compared to the outcomes in the elderly subgroup. We assessed the preoperative risks factors and quality of life after surgery by performance status and the patients' ability to return home. Operative mortality was higher in patients aged >80 years (40% vs. 18%, p = 0.04). The survival rate for patients >80 years at one, three, and five years was 53.3% ± 0.12%, 42.6% ± 0.14%, and 42.6% ± 0.12%, respectively. Of the survivors, six patients were able to return home (40%) and the postoperative performance status was "3" in one patient, "2" in six patients, and "1" in two patients. A preoperative level of 2 or greater was found to be a significant risk factor (p = 0.04). Survival in octogenarians undergoing surgery for AAD is possible, and some patients were able to return home with a reasonable level of autonomy. Larger series will be needed to define the optimal management for octogenarians presenting with AAD.

Outcomes of surgical treatment for acute ascending aortic dissection in octogenarians

Outcomes of surgical treatment for acute ascending aortic dissection in octogenarians

Midterm Outcomes of Rapid, Minimally Invasive Resection of Acute Type A Aortic Dissection in Octogenarians

We previously reported the development of a new surgical technique, called the "less invasive quick replacement" technique, for treating type A acute aortic dissection. This study examines the midterm outcome and postoperative quality of life of octogenarian patients who underwent less invasive quick replacement. During the last 3 years, 27 patients underwent less invasive quick replacement. The average age of the patients at the time of onset was 81.7 years old. During open distal anastomosis with a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40 degrees C. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40 degrees C blood perfusion. We assessed the midterm outcomes in terms of survival and cardiovascular event-free rates, patency of the distal false lumen, aortic regurgitation, and cognitive disorders. The durations of circulatory arrest, cardiopulmonary bypass, overall operation, postoperative mechanical ventilation, and hospital stay were 18.7 minutes, 82.8 minutes, 143.4 minutes, 13.0 hours, and 12.2 days, respectively. Hospital mortality rate was 3.7% (1 patient). There were no incidences of brain damage, renal failure, or respiratory failure. At the time of this study, 25 of the patients were doing well and visiting the outpatient clinic, and 22 of them scored more than 20 points on the Mini-Mental State Examination, indicating no development of dementia. Midterm computed tomography scans detected the patent false lumen in 11.5%. No aortic regurgitation was found in the echocardiography. Actuarial survival and cardiovascular event-free rates at 3 years were 96.2% and 83.0%, respectively. The less invasive quick replacement technique is safe and effective. It is a very attractive option that can contribute to maintaining a long-term good quality of life for octogenarians with type A acute aortic dissection.

Invited Commentary

The management of acute type A aortic dissection in octogenarians is problematic. Although the report by Piccardo and colleagues [1] probably overstates morbidity and mortality, most surgeons realize that surgical repair in this aged population carries significant morbidity and mortality. This report by Hata and colleagues [2] is therefore notable for several reasons:

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

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. 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). There were 26 (45.6%) in-hospital and 6 late deaths. Multivariate analysis identified compassionate indication (p < or = 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. 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.