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Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery?
Kelly M Wanamaker1, Sameer A Hirji1, Fernando Ramirez Del Val1
1Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass.
The Journal of Thoracic and Cardiovascular Surgery
|May 29, 2018
Summary
Elderly patients undergoing ascending aortic surgery show acceptable operative mortality. Advanced age alone should not contraindicate this procedure, though it is linked to reduced long-term survival.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Thoracic Surgery
Background:
- Ascending aortic surgery is a complex procedure with potential risks, particularly in elderly populations.
- Understanding the clinical outcomes in different age strata of elderly patients is crucial for surgical decision-making.
Purpose of the Study:
- To describe the clinical outcomes of elderly patients (≥70 years) undergoing ascending aortic surgery.
- To compare outcomes between elderly (70-79 years) and very elderly (≥80 years) patient groups.
Main Methods:
- Retrospective analysis of 415 patients who underwent ascending aortic surgery between 2002 and 2013.
- Logistic regression and Cox proportional hazards models were used to assess operative mortality and long-term survival.
Main Results:
- Very elderly patients (≥80 years) had higher comorbidity burden and operative mortality (13% vs 7%) compared to elderly patients (70-79 years).
- Risk-adjusted operative mortality and 30-day readmission rates were similar between groups.
- Five-year survival was lower in the very elderly group (57.1%) compared to the elderly group (72.6%).
Conclusions:
- Age was not an independent predictor of operative mortality after adjustment for comorbidities and procedure type.
- Advanced age is strongly associated with reduced late survival but should not be an absolute contraindication for ascending aortic surgery.
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