Surgical Outcomes of Acute Type A Aortic Dissection in Elderly Patients

Abstract Background: Surgical indication and the selection of surgical procedures for acute type A aortic dissection in older patients are controversial; therefore, we examined the surgical outcomes in older patients.Methods: From January 2012 through December 2019, 174 patients surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the older (≥80 years old) and below-80 (≤79 years old) age groups. Additionally, we compared the surgical and conservative treatment groups.Results: The primary entry was found in the ascending aorta in 51.6% and 32.8% of the older and below-80 groups, respectively (p = 0.049). Ascending or hemiarch replacement was performed in all older group cases and 57.3% of the below-80 group cases (total arch replacement was performed in the remaining 42.7%; p < 0.001). Hospital mortality rates were similar in both groups. The significant risk factors for hospital mortality were age, preoperative intubation, cardiopulmonary bypass time, and postoperative stroke. The 5-year survival rates were 48.4% ± 10.3% (older group) and 86.7% ± 2.9% (below-80 group; p < 0.001). The rates of freedom from aortic events at 5 years were 86.9% ± 8.7% (older group) and 86.5% ± 3.9% (below-80 group; p = 0.771). The 5-year survival rate of the conservative treatment group was 19.2% ± 8.0% in the older group. There was no significant difference between the surgical treatment groups (p = 0.103).Conclusion: The surgical approach did not achieve a significant survival advantage over conservative treatment and may not always be the reasonable treatment of choice for older patients.

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Surgical outcomes of aortic repair via transapical cannulation and the adventitial inversion technique for acute Type A aortic dissection†

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezy014 ◽

2018 ◽

Vol 54 (2) ◽

pp. 369-374 ◽

Cited By ~ 6

Author(s):

Junichi Shimamura ◽

Shin Yamamoto ◽

Susumu Oshima ◽

Kensuke Ozaki ◽

Takuya Fujikawa ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Inversion Technique ◽

Aortic Repair

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Faculty Opinions recommendation of Acute type A aortic dissection repair in elderly patients.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.725319174.793503425 ◽

2015 ◽

Author(s):

John Augoustides

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Surgical outcomes analysis in patients with uncomplicated acute type A aortic dissection: a 13-year institutional experience

Scientific Reports ◽

10.1038/s41598-020-71961-4 ◽

2020 ◽

Vol 10 (1) ◽

Author(s):

Chun-Yu Lin ◽

Lai-Chu See ◽

Chi-Nan Tseng ◽

Meng-Yu Wu ◽

Yi Han ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Short Term ◽

Repeat Surgery ◽

Type A Aortic Dissection ◽

Survivor Group ◽

Kaplan Meier ◽

Reoperation Rates

Abstract This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.

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Surgical outcomes for acute type A aortic dissection with aggressive primary entry resection

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezw111 ◽

2016 ◽

Vol 50 (3) ◽

pp. 567-573 ◽

Cited By ~ 19

Author(s):

Yosuke Inoue ◽

Kenji Minatoya ◽

Tatsuya Oda ◽

Tatsuya Itonaga ◽

Yoshimasa Seike ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Physical activities and surgical outcomes in elderly patients with acute type A aortic dissection

10.22541/au.160830113.39968007/v1 ◽

2020 ◽

Author(s):

Yasushi Tashima ◽

Yurie Toyoshima ◽

Kota Chiba ◽

Noriyuki Nakamura ◽

Koichi Adachi ◽

...

Keyword(s):

Risk Factor ◽

Aortic Dissection ◽

Elderly Patients ◽

Surgical Outcomes ◽

Independent Risk Factor ◽

Physical Activities ◽

Acute Type ◽

Type A Aortic Dissection ◽

Late Mortality ◽

Walking Difficulty

Objective: Although elderly patients undergoing surgery for acute type A aortic dissection (ATAAD) is increasing, their physical activities are not fully understood. We report the physical activities and surgical outcomes in the elderly patients who underwent ATAAD. Methods: From 2009 to 2019, 103 consecutive patients underwent surgery for ATAAD at our institution. Surgical outcomes along with pre- and postoperative physical activities in 52 elderly patients (≥70 years old) were compared with those in 51 younger patients (<70 years old). Postoperative walking difficulty was defined as taking ≥30 days to regain the ability to walk 200 m postoperatively or as the inability to walk at discharge. Results: It took longer for elderly patients to regain the ability to walk 100 or 200 m postoperatively. ROC analysis revealed the AUC of the duration for walking 200 m postoperatively as a prognostic indicator for late deaths was 0.878, with the highest accuracy at 30 days (sensitivity = 83.3%, specificity = 91.8%). Hospital mortality within 30 days was 3.8%, and 1-, 3-, and 5-years survival rates were 92%, 84.7%, 84.7%, respectively, for elderly patients, with no significant differences between groups. Cox proportional hazard analysis showed postoperative walking difficulty was an independent risk factor for late mortality in all cohorts (P = 0.017). Conclusions: Elderly patients undergoing surgical ATAAD repair showed acceptable surgical outcomes. However, they were more likely to decrease their physical activities postoperatively. Postoperative difficulty in walking was an independent risk factor for the late mortality in patients with ATAAD.

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Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians

The Annals of Thoracic Surgery ◽

10.1016/j.athoracsur.2017.06.057 ◽

2018 ◽

Vol 105 (1) ◽

pp. 137-143 ◽

Cited By ~ 12

Author(s):

Koji Kawahito ◽

Naoyuki Kimura ◽

Atsushi Yamaguchi ◽

Kei Aizawa ◽

Yoshio Misawa ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection

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Surgical outcomes of acute type A aortic dissection in dialysis patients

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-018-1051-6 ◽

2018 ◽

Vol 67 (6) ◽

pp. 501-509 ◽

Cited By ~ 1

Author(s):

Kei Akiyoshi ◽

Naoyuki Kimura ◽

Kei Aizawa ◽

Daijiro Hori ◽

Homare Okamura ◽

...

Keyword(s):

Aortic Dissection ◽

Surgical Outcomes ◽

Type A ◽

Acute Type ◽

Dialysis Patients ◽

Type A Aortic Dissection

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Influence of Age on Postoperative Neurological Outcomes after Surgery of Acute Type A Aortic Dissection

Journal of Clinical Medicine ◽

10.3390/jcm10081643 ◽

2021 ◽

Vol 10 (8) ◽

pp. 1643

Author(s):

Mohamed Salem ◽

Michael Salib ◽

Christine Friedrich ◽

Mostafa Salem ◽

Thomas Puehler ◽

...

Keyword(s):

Aortic Dissection ◽

Elderly Patients ◽

Circulatory Arrest ◽

Neurological Complication ◽

Young Patients ◽

Operation Time ◽

Type A ◽

Acute Type ◽

Type A Aortic Dissection ◽

Significant Difference

Background: Acute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients. Methods: a retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20–24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)). Results: Comparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (p < 0.001); female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (p < 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131; 187) vs. 171 min (137; 220); p = 0.012), cross-clamping time (79 min (60; 105) vs. 93 min (71; 134); p = 0.001] and circulatory arrest time (29 min (22; 40) vs. 33 min (26; 49); p = 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%; p = 0.0968) or stroke (11.8% vs. 16.1%; p = 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%; p = 0.007). Conclusion: The current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication.

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