Early and Late Outcomes of Operation for Acute Type A Aortic Dissection in Patients Aged 80 Years and Older

Omura, Atsushi; Matsuda, Hitoshi; Minami, Hiroya; Nakai, Hidekazu; Henmi, Soichiro; Murakami, Hirohisa; Yoshida, Masato; Mukohara, Nobuhiko

doi:10.1016/j.athoracsur.2016.05.046

Cited by 28 publications

(36 citation statements)

References 23 publications

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“…Although several studies have reported operative outcomes in patients aged > 80 years, no study has reported findings in nonagenarians. [2][3][4][5][6][7][8] Despite the low statistical power of this study, a significant intergroup difference was observed in survival curves (Figure 2). This finding supports the indication for open surgical aortic repair in nonagenarians.…”

Section: Discussionmentioning

confidence: 69%

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).

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Section: Discussionmentioning

confidence: 69%

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

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“…In our study, preoperative unresolved shock was the only independent risk factor of hospital death, but advanced age was not a risk factor. Recently even in octogenarians, surgical outcome was favorable [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

Choi

Kim

et al. 2018

THC

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BACKGROUND: Despite recent advances in surgical techniques and perioperative management, the surgical mortality of acute type A aortic dissection remains high.OBJECTIVE: In a hospital with few acute type A aortic dissection operations, we retrospectively investigated whether simplified surgical approach could obtain proper surgical outcomes.METHODS: Between October 2007 and December 2016, we performed emergency surgery in 99 patients who had acute type A aortic dissection, including replacement of the hemi-arch in 62 patients (63%) and total arch in 32 patients (32%) and aortic root surgery in 7 patients (7%). Surgical strategy has been simplified over time.RESULTS: We performed right axillary artery perfusion in 61 patients (62%) and antegrade cerebral perfusion in 78 patients (79%). During the last 3 years, in-hospital mortality was decreased to 4% (2/47). Preoperative unresolved shock was an independent predictor of hospital death. Although the patients with total arch replacement or aortic root surgery had a mean significantly long cardiopulmonary bypass or circulatory arrest time, in-hospital mortality or neurologic complications was not increased.CONCLUSIONS: Simplified surgical approach could provide a reasonable surgical outcome in acute type A aortic dissection surgery in a center with a small volume of acute aortic dissection surgery.

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“…Hence, octogenarians are more likely to undergo an emergency life-saving operation for type A aortic dissection in Japan than in other countries. Recent reports from single-institutional studies [4,5] of highly experienced Japanese teams indicate excellent surgical results for acute type A aortic dissection in elderly patients. Matsushita and colleagues [4] reported operative mortality of 4.8%, but a high incidence of stroke in elderly (>75 years) patients.…”

Section: Commentmentioning

confidence: 99%

“…However, patients with acute type A aortic dissection undergoing initial medical treatment have an extremely high mortality rate of more than 90% within 48 hours [1,2]. Reported hospital mortality after emergency surgical repair for acute type A aortic dissection in such elderly patients is high, ranging from 13% to 67% [2,5,[9][10][11][12][13][14][15][16]. Older age (>80 years) is therefore generally recognized as a risk factor for an emergency operation for type A dissection.…”

Section: Commentmentioning

confidence: 99%

“…The latest advances in surgical techniques, anesthesia, and perioperative medical management are likely to have decreased the likelihood of death of individuals undergoing an emergency operation for acute type A aortic dissection during the last few years. Recently, several highly experienced institutions have reported excellent results from surgical repair for elderly patients with acute type A aortic dissection [3][4][5].…”

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confidence: 99%

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

Suzuki

Asai

Kinoshita

2019

The Annals of Thoracic Surgery

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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/m 2), and a lower proportion of smokers Operative Technique The operation was performed through a median sternotomy in all patients. Our detailed surgical procedures

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Early and Late Outcomes of Operation for Acute Type A Aortic Dissection in Patients Aged 80 Years and Older

Cited by 28 publications

References 23 publications

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Simplified surgical approach to improve surgical outcomes in the center with a small volume of acute type A aortic dissection surgery

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

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