Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians.
Publication/Presentation Date
1-1-2022
Abstract
OBJECTIVE: The 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.
METHODS: From 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.
RESULTS: At 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.
CONCLUSIONS: Clinical 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.
Volume
163
Issue
1
First Page
2
Last Page
12
ISSN
1097-685X
Published In/Presented At
Bojko, M. M., Suhail, M., Bavaria, J. E., Bueker, A., Hu, R. W., Harmon, J., Habertheuer, A., Milewski, R. K., Szeto, W. Y., & Vallabhajosyula, P. (2022). Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians. The Journal of thoracic and cardiovascular surgery, 163(1), 2–12.e7. https://doi.org/10.1016/j.jtcvs.2020.03.157
Disciplines
Medicine and Health Sciences
PubMedID
32624307
Document Type
Article