gms | German Medical Science

Objectives: Acute type A aortic dissection (AAD) is a life-threatening emergency that is associated with a high mortality without surgical treatment. Several studies demonstrated age to be an independent predictor of adverse outcome in patients after surgery. In this study, we retrospectively reviewed the early and late results of surgery for AAD in elderly compared with younger patients.

Methods: Between 2004 and 2012, 204 patients underwent emergency operation for AAD using deep hypothermic circulatory arrest. 65 patients were aged 70 years and older (elderly group, mean age, 76±4 years, range 70-85 years) and 139 were younger than 70 years old (younger group, mean age, 56±10 years, range 18-69 years). Follow-up was 91% complete (mean, 5.1±2.7 years, range 0.9-10.0 years).

Results: No significant differences were noted between the two groups with regard to preoperative risk factors on admission (cardiogenic shock/hypotension, cardiac tamponade, limb ischemia, or neurologic deficit). The surgical procedures including isolated replacement of the ascending aorta, associated with total root replacement and aortic arch replacement were compared between the groups. No significant differences in postoperative complications and major morbidity were observed. Nine patients (14%) in the elderly group, and 19 patients (14%) in the younger group underwent re-exploration due to excessive bleeding or cardiac tamponade (p=1.0). The incidence of postoperative acute renal injury was 17% in the elderly group, and 23% in the younger group (p=0.36). The operative mortality (elderly group 3% vs. younger group 2%; p=0.65) and 30 days mortality (elderly group 18% vs. younger group 9%; p=0.06) were without statistical significance between the groups. In the elderly, survival rate (including the operative mortality rate) were 77% at 1 year, 71% at 3 years, and 68% at 5 years. In the younger group, the rates were 88% at 1 year (p=0.04), 88% at 3 years (p=0.005), and 84% at 5 years (p=0.01).

Conclusions: Surgery for AAD in the elderly resulted in acceptable mortality. Satisfactory early and long-term outcomes encourage the offering of surgery in elderly patients.