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

Castaño, Mario; Gualis, Javier; Martínez‐Comendador, José Manuel; Martín, E.; Maiorano, Pasquale; Castillo, Laura

doi:10.21037/jtd.2017.04.51

Cited by 3 publications

(2 citation statements)

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“…6,[8][9][10] For instance, octogenarians have been shown to suffer worse outcomes after surgery for acute aortic dissection, spanning both type A and B classifications. 7 In light of these data, some providers have refrained from offering cardiac surgery to patients aged greater than 80 years, and consider advanced age a surgical contraindication 16,17 While there exists a wealth of data on postoperative outcomes after cardiac surgery in octogenarians, data on vascular surgery outcomes in this patient population is limited.…”

Section: Discussionmentioning

confidence: 99%

Multi-institutional outcomes after femoropopliteal bypass in octogenarians

et al. 2022

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Objectives Open lower extremity revascularization is controversial among octogenarians; however, the indications for surgical bypass are higher in the elderly population. The aim of the study was to compare postoperative outcomes between octogenarians and non-octogenarians following femoropopliteal bypass surgery. Methods Our regional, multi-institutional database was queried for femoropopliteal bypass procedures performed between 1995 and 2020. Electronic medical records were individually reviewed for operative and postoperative data. Univariable and multivariable logistic regression were utilized to determine predictors of postoperative outcomes. Results Among 1315 patients who underwent femoropopliteal bypass, 234 (17.8%) were octogenarians. Octogenarians more frequently underwent bypass for lower extremity tissue loss (48.7% vs 30.2%), whereas claudication was more common among non-octogenarians (24.0% vs 9.8%) ( p < .001). Below-knee bypass target (72.2% vs 59.3%) and prosthetic conduit utilization (58.5% vs 43.7%) were more frequent in octogenarians ( p < .001 each). Overall hospital length of stay was longer among patients > 80 years (median 6 days [interquartile range [IQR] 4–9] vs 5 days [IQR 4–8], p = .017). The overall 30-day (5.6% vs 1.5%) and one-year mortality rates (25.6% vs 7.9%) were higher among octogenarians ( p < .001 each). On multivariable analysis, age greater than 80 years was found to be an independent risk factor for postoperative mortality (OR 3.79 [1.75–8.20], p = .0007) Conclusions Octogenarians undergoing bypass femoropopliteal bypass surgery have considerably worse postoperative outcomes, compared with non-octogenarians. These data may help inform elderly patients prior to undergoing open lower extremity revascularization.

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Section: Discussionmentioning

confidence: 99%

Multi-institutional outcomes after femoropopliteal bypass in octogenarians

et al. 2022

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“…Las principales morbilidades son: hemorragia, IAM, accidente cerebrovascular, sepsis, arritmias, entre otras 18 . La supervivencia de pacientes intervenidos quirúrgicamente por SAA a 1 y 3 años de seguimiento es de 96% y 91%, respectivamente, siendo notablemente superior al tratamiento médico, aun en pacientes añosos y de alto riesgo quirúrgico [15][16][17]19 .…”

Section: Discussionunclassified

Tratamiento quirúrgico de la úlcera penetrante de aorta ascendente. Casos clínicos

et al. 2017

Rev. méd. Chile

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Penetrating ulcer of the ascending aorta treated surgically. Report of two casesPenetrating aortic ulcer (PAU) is an ulceration of an atherosclerotic plaque which disrupts the aortic internal elastic lamina and that can evolve to an intramural hematoma (IH), aortic dissection or aortic rupture. We report two cases with PAU. A 73 year-old woman with a history of hypertension, presented with acute chest pain of three days of evolution and a hypertensive emergency. An electrocardiogram showed ST-segment elevation and elevated cardiac enzymes. Computed tomography (CT) scans showed an acute ascending aortic mural hematoma secondary to PAU and hemopericardium. Replacement of ascending aorta was performed with a vascular prosthesis with extracorporeal circulation (ECC). PAU and IH were confirmed by histopathology. A 62-year old woman with a history of hypertension, diabetes and chronic obstructive pulmonary disease, consulted for abdominal pain of two days of evolution. A thoracic-abdominal CT scan visualized an uncomplicated PAU and an abdominal aortic aneurysm. Because of abdominal pain and signs of peritoneal irritation, an exploratory laparotomy was performed finding a typhlitis. Resection and ileo-ascendo-anastomosis were performed. A new CT scan showed PAU with high risk of rupture without a clinical acute aortic syndrome. The patient was operated replacing the ascending aorta with a vascular prosthesis using ECC. Three PAU were found. Histopathology confirmed the diagnosis. Both patients evolved without postoperative complications.

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