Aortic arch surgery in octogenarians: is it justified?

Area of Science:

• Cardiovascular Surgery
• Geriatric Medicine
• Vascular Surgery

Background:

• Elderly patients (over 80) with aortic arch disease often face treatment denial due to perceived poor outcomes and quality of life.
• Surgical intervention for aortic arch disease in octogenarians is controversial.

Purpose of the Study:

• To evaluate early clinical outcomes, long-term survival, and quality of life in octogenarian patients undergoing surgical treatment for aortic arch disease.
• To determine if age alone should be a contraindication for aortic arch intervention in this demographic.

Main Methods:

• A cohort of 47 octogenarian patients with aortic arch disease was analyzed.
• 20 patients underwent surgical intervention, while 27 received medical treatment.
• Survival analysis (Kaplan-Meier, Cox regression) and quality of life assessment (SF-36) were performed.

Main Results:

• No hospital deaths in the surgical group; 5-year survival was 61.5% vs. 14.2% in the medical group (P=0.02).
• 5-year freedom from aorta-related death was 92.3% for surgical patients versus 32.3% for medical patients (P=0.01).
• Surgical survival mirrored age-matched population data, while medical therapy was a risk factor for mortality.

Conclusions:

• Surgical intervention for aortic arch disease in octogenarians provides satisfactory early outcomes and acceptable mid-term survival.
• Quality of life among survivors was similar between surgical and medical groups.
• Age should not preclude octogenarians from receiving aortic arch interventions.