Acute type A aortic dissection repair in elderly patients

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Acute type A aortic dissection (ATAAD) poses significant risks, especially in elderly populations.
• Optimal surgical management strategies for ATAAD in patients over 75 remain a critical area of study.

Purpose of the Study:

• To evaluate the outcomes of emergency surgical repair for ATAAD in elderly patients (over 75 years).
• To identify clinical presentations and surgical strategies influencing patient outcomes in this demographic.

Main Methods:

• Retrospective analysis of 45 patients aged over 75 undergoing emergency ATAAD repair (2000-2013).
• Assessment of complications including neurological deficit, cardiac tamponade, myocardial infarction, and renal failure.
• Surgical interventions included ascending aorta replacement, hypothermic circulatory arrest, hemiarch extension, and aortic valve/root replacement as needed.

Main Results:

• In-hospital mortality was 15%. Preoperative neurological deficit was the sole independent predictor of mortality (P=0.03).
• Age over 80 did not independently correlate with poorer outcomes.
• Postoperative complications occurred in 52% of patients. Median follow-up was 57 months with 1-, 5-, and 8-year survival rates of 82%, 76%, and 67% respectively.

Conclusions:

• Emergency surgical repair of ATAAD in elderly patients yields acceptable early mortality and satisfactory intermediate survival rates.
• Preoperative neurological deficit is a significant predictor of adverse outcomes in ATAAD repair for older adults.
• Advanced age alone should not preclude patients from undergoing potentially life-saving ATAAD repair.