Early and long-term results of surgery for aneurysms of the thoracic aorta in septuagenarians and octogenarians

Abstract

Although recent advances have been achieved, early and long-term results of surgery for thoracic aortic aneurysm in patients older than 70 years were less satisfactory compared with those of patients under 70 years of age, especially in patients who required emergency surgery. Preoperative disorder of the vital organ systems was considered to be the main causative factor for high mortality, however, pertinent surgical strategies are necessary to improve the outcome of elderly patients.

Emergent aortic surgery in octogenarians: is the advanced age a contraindication?

“…Open surgery therefore would only be indicated in patients with lower limb severe peripheral arterial disease, severe tortuosity of the iliac arteries, very narrow angulation of the arch and/or absence of an adequate proximal aortic neck for successful endoprosthesis implantation. The very aggressive open surgical approaches and techniques required increase mortality and complications even further in vulnerable populations such as octogenarians (52,53). The most classical series reported high mortality rates and defined patient age as an independent mortality predictor even in elective procedures (52,54).…”

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

“…The in-hospital mortality rate in patients 70 years of age or older with a TAA is reported to be 1.25-fold higher than in younger patients. 75 2. Thoracic Aortic Aneurysm (Recommendations for Choosing Treatment Methods for Thoracic Aortic Aneurysm: Table 8)…”

“…75 If the risk of death after surgery for TAA is assumed to be 5%, a reasonable criterion for JCS, Japanese Circulation Society. largement are at high risk of rupture.…”

Endovascular surgery for failed open aortic aneurysm repair*1

“…In addition, endovascular aneurysm repair carries the burden of early and late endoleaks, which in turn may require open correction too [6]. However, recurrence of aneurismal lesions in the area previously repaired and/or at remote aortic sites are not uncommon after open surgical repair neither [7,8]. The present analysis was performed to determine the usefulness of endovascular surgery for repair of aortic lesions late after open surgical aortic repair.…”