Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

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.