Abstract 17250: Surgical Outcomes of Type A Aortic Dissection in the Octogenarians and Nonagenarians
Objectives: The purpose of this study was to evaluate the early and mid-term outcomes of surgery for type A aortic dissection in the octogenarians and nonagenarians.
Methods: Since 1995, 50 patients over 80 years of age with type A acute aortic dissection, (mean age 84.4±3.5, 12 male, 4 nonagenarians) had surgical interventions. Ten patients had organ malperfusion. Twenty-three had cardiac tamponade, 15 were in shock status, and 5 patients had cardiac arrest. Fifteen had acute neurological symptoms preoperatively. Forty-six had emergent operations and 4 had urgent operations. Nine had total arch replacement, 2 had partial arch replacement, and 39 had hemiarch replacement. Four had aortic root replacement and 3 had aortic valve replacement as concomitant procedures.
Results: Operative duration was 401±123 minutes, extracorporeal circulation duration was 207±88 minutes, myocardial ischemic duration was 120±49 minutes, circulatory arrest duration was 52±20 minutes.
30 day mortality was 8% (n=4). Of them, 2 patients had severe complication of central nervous system, and 2 had low output syndrome postoperatively. Four had permanent neurological deficit and 7 had temporal neurological deficit. Twenty had respiratory complication. Eight had renal failure. One had graft infection soon after the operation and had redo hemiarch replacement with homograft. Forty-three (86%) were able to go home finally without reduction of quality of life (Group A). Four could not survive the operations and 3 became bedridden (Group B). EUROSCOREII were 10.4% in Group A and 14.5% in Group B (P=0.10), preoperative malperfusion were 13.9% in Group A and 57.1% in Group B (P=0.008), preoperative cardiac arrest was 4.6% in Group A and 42.8% in Group B (P=0.018). Extracorporeal circulation duration was 187 minutes in Group A and 329 minutes in Group B (P<0.0001), postoperative neurological deficits were 16.3% in Group A and 66.7% in Group B (P=0.006). Survival rates were 84.9% in 1 year, 70% in 3 years, and 60.5% in 5 years.
Conclusions: Surgery for type A acute aortic dissection in this population can be performed with acceptable outcomes. Major of them survived the procedure and discharged home. Surgical procedures should be considered even in the octogenarians and nonagenarians.
- © 2013 by American Heart Association, Inc.