Emergency surgery for acute type a aortic dissection in octogenarians

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Geriatric Medicine

Background:

• Acute type A aortic dissection carries high mortality in elderly patients.
• Octogenarians undergoing emergency surgery present unique challenges.
• Limited data exists on perioperative risk factors and prognosis in this demographic.

Purpose of the Study:

• To explore perioperative risk factors in octogenarians with acute type A aortic dissection.
• To evaluate the prognosis of emergency surgery in this patient group.
• To identify factors influencing outcomes in elderly patients with aortic dissection.

Main Methods:

• Retrospective review of 24 octogenarians (aged 80-90) who underwent emergency surgery for acute type A aortic dissection.
• All patients received conservative, tear-oriented surgery with deep hypothermic circulatory arrest and cerebral perfusion.
• Procedures included ascending aortic and entire arch replacements.

Main Results:

• Hospital mortality was 13%, not significantly different from younger patients.
• Late mortality was 38%, significantly higher than in younger patients (9%).
• Five- and 10-year survival rates were 55% and 42%, respectively, compared to 83% and 73% in younger patients. Age 80+ was not an independent risk factor for hospital death.

Conclusions:

• Conservative, intimal tear-oriented surgery is feasible and yields satisfactory early and late survival in octogenarians with acute type A aortic dissection.
• Aggressive surgical management is crucial for improving outcomes in this high-risk population.
• Pneumonia and reoperation were identified as risk factors for late death in younger patients.