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Survival after surgery for acute type A aortic dissection in octogenarians
Antonio Fiore1, Javier Rodriguez Lega2, Joscha Buech3,4
1Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
Journal of Geriatric Cardiology : JGC
|December 30, 2024
Summary
Surgical repair of acute type A aortic dissection (ATAAD) may benefit octogenarians, offering survival advantages up to five years post-procedure. Careful patient selection is crucial for optimizing outcomes in this elderly group.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Dissection Research
Background:
- Acute type A aortic dissection (ATAAD) is a life-threatening condition requiring urgent intervention.
- Octogenarians (≥ 80 years) represent a growing patient demographic facing ATAAD, with historically poorer surgical outcomes.
- Evaluating the specific survival benefits and risks of surgical ATAAD repair in octogenarians is critical due to population aging.
Purpose of the Study:
- To assess the survival benefits of surgical repair for acute type A aortic dissection (ATAAD) in octogenarian patients.
- To compare the outcomes of octogenarians undergoing ATAAD surgery with those of younger patients.
- To identify predictors of in-hospital mortality in octogenarian ATAAD patients.
Main Methods:
- Analysis of patients who underwent surgery for acute ATAAD from the European Registry of Type A Aortic Dissection (ERTAAD).
- Propensity score matching was used to compare 326 octogenarian patients (≥ 80 years) with younger patients.
- Statistical analysis included in-hospital mortality, 10-year mortality, relative survival rates, and identification of independent predictors of mortality.
Main Results:
- In-hospital mortality was higher in octogenarians (30.0%) compared to younger patients (20.0%) (P = 0.006).
- 10-year mortality was significantly higher in octogenarians (93.2%) versus younger patients (48.0%) (P < 0.001).
- Mortality risk in octogenarians became comparable to younger patients up to 5 years post-surgery; however, relative survival decreased markedly after 5 years. Predictors of in-hospital mortality included age ≥ 85, renal function, ventilation, mesenteric mal-perfusion, and aortic root replacement. A risk score was developed, with a score ≤ 1 associated with 20.9% in-hospital mortality.
Conclusions:
- Surgical repair of ATAAD may offer a survival benefit for carefully selected octogenarian patients, potentially lasting up to five years.
- The findings highlight the importance of patient selection for surgical ATAAD repair in the elderly population.
- Given increasing life expectancy, these results have significant clinical and epidemiological relevance for managing ATAAD in older adults.
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