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Surgery for acute type A aortic dissection: is advanced age a contraindication?

Bruno Chiappini1, M Erwin Tan, Wim Morshuis

  • 1Department of Cardiothoracic Surgery, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. bruno_chiappini@hotmail.com

The Annals of Thoracic Surgery
|July 28, 2004
PubMed

Insights

Elderly patients (70+) undergoing surgery for acute type A aortic dissection show similar survival rates and mortality to younger patients. This indicates that age alone should not be a barrier to surgical intervention for this condition.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Surgery

Background:

  • Increasing lifespan leads to more elderly patients requiring cardiac surgery.
  • Aortic dissection is a critical condition necessitating timely surgical intervention.
  • Outcomes in elderly patients undergoing aortic dissection surgery require specific evaluation.

Purpose of the Study:

  • To compare early and late surgical outcomes in patients over 70 with those younger than 70.
  • To identify clinical challenges specific to elderly patients undergoing aortic dissection repair.
  • To assess the safety and efficacy of aortic dissection surgery in older populations.

Main Methods:

  • Retrospective analysis of 315 patients undergoing emergency surgery for acute type A aortic dissection (1976-2001).
  • Patients were divided into two groups: younger than 70 years (Group 1, n=245) and 70 years or older (Group 2, n=70).
  • Comparison of early outcomes (hospital mortality) and late outcomes (actuarial survival).

Main Results:

  • Hospital mortality rates were comparable: 20.5% in Group 1 vs. 17.6% in Group 2 (p=0.751).
  • Mean extracorporeal circulation and cross-clamp times were similar between groups, with a shorter cross-clamp time in older patients (p=0.009).
  • Actuarial survival rates at mean follow-up were not significantly different: 77.1% (Group 1) vs. 80% (Group 2) (p=0.619).

Conclusions:

  • Surgery for type A acute aortic dissection in patients 70 years or older yields results comparable to younger patients.
  • No significant differences in 30-day mortality or long-term survival were observed between the age groups.
  • Surgical intervention for acute type A aortic dissection in elderly patients can be performed with acceptable risk and satisfactory outcomes.
Abstract

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