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Published on: March 28, 2025
Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection
Tomoaki Suzuki1, Tohru Asai1, Takeshi Kinoshita1
1Department of Cardiovascular Surgery, Shiga University of Medical Science, Otsu, Shiga, Japan.
Insights
Emergency surgery for acute type A aortic dissection is safe for octogenarians. Elderly patients (≥80 years) had similar mortality and morbidity rates compared to younger patients, challenging previous exclusion criteria.
Area of Science:
- Cardiovascular Surgery
- Geriatric Medicine
- Thoracic Surgery
Background:
- Octogenarians are frequently denied emergency surgery for acute type A aortic dissection due to perceived high mortality and limited life expectancy.
- This institution adopted a policy of accepting all patients for emergency operations, irrespective of age.
Purpose of the Study:
- To compare the clinical outcomes of emergency surgical repair for acute type A aortic dissection between elderly (≥80 years) and non-elderly patients.
- To evaluate the safety and efficacy of surgical intervention in octogenarians.
Main Methods:
- A retrospective comparison of 55 octogenarian patients (older group) and 264 non-elderly patients (younger group) who underwent surgical repair for acute type A aortic dissection between April 2004 and September 2017.
- Primary endpoint: early mortality. Secondary endpoint: long-term mortality.
Main Results:
- The older group had a higher proportion of women and lower BMI and smoking rates.
- Postoperative stroke (12.7% vs 11.4%) and hospital mortality (10.2% vs 10.9%) were not significantly different between groups.
- Older age (≥80 years) was not a significant risk factor for hospital mortality in multivariate analysis.
- Eight-year actuarial survival was 52.5% in the older group versus 85.0% in the younger group (p=0.005).
Conclusions:
- Emergency surgical repair for acute type A aortic dissection in octogenarians, without patient selection, yields comparable mortality and morbidity rates to younger patients.
- Octogenarians should not be refused this life-saving emergency operation.
Background:
Octogenarians are often declined an emergency operation for acute type A aortic dissection on grounds of high mortality rate and short life expectancy. Our policy is to accept all patients at any time and never to refuse an emergency operation, even for octogenarians.
Methods:
From April 2004 to September 2017, 319 patients underwent surgical repair for acute type A aortic dissection at our institution. We compared the clinical results between the 55 elderly patients (≥80 years old; older group) and the 264 nonelderly patients (≤79 years old; younger group). The primary end point was early mortality, and the secondary end point was long-term mortality.
Results:
The older group had a higher proportion of women (74.5% vs 46.6%), a lower body mass index (21.4 vs 23.8 kg/m2), and a lower proportion of smokers (20.0% vs 46.2%). In the two groups (older vs younger), postoperative stroke occurred in 12.7% versus 11.4% and hospital mortality in 10.2% versus 10.9%, with no significant statistical difference. In multivariate analysis, older age of 80 years or older was not a significant risk factor for hospital mortality. Among the hospital survivors, the actuarial survival rate at 8 years was 52.5% in the older group and 85.0% in the younger group (p = 0.005).
Conclusions:
Emergency surgical repair for type A aortic dissection in octogenarians without patient selection resulted in similar rates of mortality and morbidity as younger patients. Octogenarians should not be refused this life-saving emergency operation.
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