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Operation for acute type A aortic dissection in octogenarians: is it justified?
E Neri1, T Toscano, M Massetti
1Istituto di Chirurgia Cardiovascolare, Universita' agli Studi di Siena, Unita' Operativa di Chirurgia dell' Aorta Toracica, 53100 Siena, Italy. euxneri@tin.it.nerie@unisi.it
The Journal of Thoracic and Cardiovascular Surgery
|February 15, 2001
Summary
Surgery for acute type A aortic dissection in octogenarians has extremely high mortality and poor outcomes. These findings suggest that age is a significant risk factor, questioning the benefit of such interventions in this population.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Surgical Outcomes Research
Background:
- Increasing elderly populations present challenges in cardiac surgery resource allocation.
- Ethical considerations arise regarding the cost-effectiveness of treating older patients.
- Optimizing resource use by avoiding futile interventions is crucial.
Purpose of the Study:
- To evaluate the outcomes of surgical intervention for acute type A aortic dissection in patients aged 80 years and older.
- To determine if age is an independent risk factor for mortality and morbidity in this patient group.
- To assess the quality of life and survival of octogenarian survivors.
Main Methods:
- Retrospective review of 24 consecutive patients aged 80+ undergoing surgery for acute type A aortic dissection (1985-1999).
- Development of hospital mortality and morbidity models using multivariate logistic regression on a larger cohort (197 patients).
- Analysis included preoperative and intraoperative variables, focusing on age as a predictor.
Main Results:
- Overall hospital mortality was 83%, with 33% intraoperative mortality.
- All survivors experienced postoperative complications; none were independent at discharge.
- Six-month survival for survivors was 0%; age over 80 was the strongest predictor of 30-day mortality/morbidity.
Conclusions:
- Octogenarian surgery for acute type A aortic dissection is associated with high mortality and morbidity.
- Short-term survival is poor, with a low quality of life for survivors.
- Data support the hypothesis that denying complex surgical interventions to older patients may conserve resources, though further studies are needed.