Surgery for Acute Type A Aortic Dissection in Octogenarians

Vanhuyse, Fabrice; Maureira, Pablo; Nicolas, Laurent; Lekehal, Malik; Grandmougain, Daniel; Villemot, Jean Pierre

doi:10.1111/j.1540-8191.2011.01387.x

Cited by 16 publications

(23 citation statements)

References 16 publications

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“…For short term mortality, the analysis was conducted on four studies (6,7,9,14): results were similar to the overall analysis with a RR of 2.30 (95% CI, 1.29-4.09; P=0.0047). (95% CI, 0.30-3.56, P=0.08) for the random effect model.…”

Section: Sub-analysis In Octogenariansmentioning

confidence: 83%

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Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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Background:The results of surgical treatment of type A aortic dissection (AAD) in the elderly are controversial and aggravated by a higher operative mortality rate. The studies published in this subset of patients are mainly retrospective analyses or small samples from international registries. We sought to investigate this topic by conducting a contemporary meta-analysis of the most recent observational studies.Methods: A systematic literature search was conducted for any study published in the last five years on aortic dissection treated surgically in patients 70 years and older. A pooled risk-ratio meta-analysis has been conducted three main post-operative outcomes: short-term mortality, stroke and acute kidney injury.Results: A total of 11 retrospective observational studies have been included in the quantitative metaanalysis. Pooled meta-analysis showed an increased risk of short term mortality for the elderly population 2 =14%, P=0.31) after surgery were comparable to the younger cohort of patients. Conclusions:Although affected by an increased risk of short-term mortality in the elderly, surgical repair remains the treatment of choice for AAD. The main post-operative outcomes are comparable to younger patients and the mid-term survival rates are acceptable.

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Section: Sub-analysis In Octogenariansmentioning

confidence: 83%

“…A further screening of abstracts and full texts was conducted and a final sample of 18 studies considered relevant to our review (1,2,5,(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20). Of these, seven were excluded from the quantitative meta-analysis for different reasons.…”

Section: Prisma Preferred Reporting Items For Systematic Reviews Andmentioning

confidence: 99%

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Bruno¹,

Chivasso²,

Guida³

et al. 2016

Ann. Cardiothorac. Surg.

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“…This pathophysiological effect may evolve, at endothelial level, in pro-inflammatory mechanisms characteristic of AAD, including the release of pro-inflammatory mediators, pro-coagulant and endothelial factors from damaged vascular cells [1, 21, 22]. …”

Section: Introductionmentioning

confidence: 99%

A pilot observational study on magnesium and calcium imbalance in elderly patients with acute aortic dissection

et al. 2017

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BackgroundMagnesium (Mg) and calcium (Ca) are the principal essential elements involved in endothelial cell homeostasis. Extracellular changes in the levels of either alter endothelial contraction and dilatation. Consequently Mg and Ca imbalance is associated with a high risk of endothelial dysfunction, the main process observed during acute aortic dissection (AAD); in this clinical condition, which mainly affects elderly men, smooth muscle cell alterations lead to intimal tears, creating a false new lumen in the media of the aorta. AAD patients have a high risk of mortality as a result of late diagnosis because often it is not distinguished from other cardiovascular diseases.We investigated Mg and Ca total circulating levels and the associated pro-inflammatory mediators in elderly AAD patients, to gain further information on the pathophysiology of this disorder, with a view to suggesting newer and earlier potential biomarkers of AAD.ResultsTotal circulating Mg and Ca levels were both lower in AAD patients than controls (p < 0.0001). Using Ca as cut-off, 90% of AAD patients with low Ca (<8.4 mg/dL) came into the type A classification of AAD. Stratifying AAD according to this cut-off, Mg was lower in patients with lower total Ca.Compared to controls, both type A and B AAD patients had higher levels of all the pro-coagulant and pro-inflammatory mediators analyzed, including sP-sel, D-dimer, TNF-α, IL-6, and CRP (p < 0.05). Dividing types A and B using the Stanford classification, no significant differences were found (p > 0.05) The levels of both ICAM-1 and EN-1 were lower in AAD than in a control group (p < 0.0001 and p < 0.05 respectively).ConclusionsThese findings suggest that low Mg and Ca in AAD elderly patients may contribute to altering normal endothelial physiology and also concur in changing the normal concentrations of different mediators involved in vasodilatation and constriction, associated with AAD onset and severity.

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“…Nevertheless, recent studies have questioned the benefits of urgent surgery for elderly patients. Repair of type A dissections in octogenarians is associated with an intraoperative mortality rate of 40%, compared with only 18% for those younger than 80 years old [Vanhuyse 2012].…”

Section: Resultsmentioning

confidence: 99%

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

Kaya¹,

Yerebakan²,

Spielman³

et al. 2014

HSF

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Occlusion of a coronary artery by an acute type A aortic dissection presents a life-threatening emergency that is rarely seen and easy to misdiagnose. We present the case of a 75-year-old male who experienced sudden onset of severe left-sided chest pain due to an acute type A aortic dissection that obstructed the right coronary artery. Following an initial misdiagnosis of acute coronary syndrome, imaging revealed the presence of an aortic dissection. An emergency modified Bentall procedure was performed, in which the damaged aorta and aortic valve were replaced.

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Surgery for Acute Type A Aortic Dissection in Octogenarians

Abstract: Survival in octogenarians undergoing surgery for AAD is possible, and some patients were able to return home with a reasonable level of autonomy. Larger series will be needed to define the optimal management for octogenarians presenting with AAD.

Cited by 16 publications

References 16 publications

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis

A pilot observational study on magnesium and calcium imbalance in elderly patients with acute aortic dissection

Acute Type-A Aortic Dissection with Obstruction of the Right Coronary Artery

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