Surgical Repair for Acute Type A Aortic Dissection in Octogenarians

Ahmad, Ali; Papadopoulos, Nestoras; Detho, Faisal; Srndic, E; Risteski, Petar; Moritz, Anton; Zierer, Andreas

doi:10.1016/j.athoracsur.2014.08.020

Cited by 27 publications

(31 citation statements)

References 31 publications

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“…The in-hospital mortality rate was 26%, with an estimated 5-year survival rate of 46%±16% (10 finding also being confirmed for octogenarians. However, the incidence of neurological complications and renal failure was similar in both groups (11).…”

supporting

confidence: 59%

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

Castaño¹,

Gualis²,

Martínez‐Comendador³

et al. 2017

J. Thorac. Dis.

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supporting

confidence: 59%

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

Castaño¹,

Gualis²,

Martínez‐Comendador³

et al. 2017

J. Thorac. Dis.

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“…Previous reports demonstrated a 5-year survival rate of 44-59.7%. 12-14, 19 Piccardo et al 14 reported a 5-year survival rate of 80% in discharged octogenarians, which was equivalent the octogenarians presented with a higher rate of DeBakey type 2 and non-communicating-type aortic dissections rather than did younger patients. Therefore, the rate of ascending aortic replacement was higher in the octogenarians.…”

Section: Discussionmentioning

confidence: 98%

Early and Late Outcomes of Surgical Repair for Stanford A Acute Aortic Dissection in Octogenarians

Tochii

Takami

Hattori

et al. 2016

Circ J

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2468TOCHII M et al. Circulation JournalOfficial Journal of the Japanese Circulation Society http://www. j-circ.or.jp therapy. 9 Thus, the effect of age alone on emergency surgery for AAD is not entirely understood. Furthermore, the longterm outcome of surgery for AAD in octogenarians remains uncertain. Therefore, we reviewed the surgical outcomes to investigate and compare the validity of surgery for AAD in octogenarians and younger patients. Methods Study PatientsWe reviewed our surgical outcomes for patients who underwent surgical treatment for AAD via a median sternotomy at the Department of Cardiovascular Surgery, Fujita Health University, Toyoake, Japan, from 2005 to 2015. According to the Japanese guidelines for aortic dissection, 16 surgery performed within 14 days after the onset of dissection was defined as the acute phase, whereas surgery performed within 48 h was defined as the very acute phase. We retrospectively reviewed clinical records and data on patient demographics, results of imaging studies, details of medical and surgical treatments, and patients' outcomes. We he increasing life expectancy of the population will be accompanied by a rise in the incidence of cardiovascular diseases, including aortic dissection and aneurysm. 1 Because the Stanford type A aortic dissection (AAD) extending to the ascending aorta is a condition that has an extremely poor prognosis, 2 immediate surgical intervention is indicated once it has been diagnosed. The current AAD hospital mortality rates remain between 15% and 30%, 3-8 despite gradual improvement over time. Increased age is a strong independent predictor of hospital death following cardiovascular interventions, including the surgical repair of AAD. 7,9,10 Surgery for octogenarians with AAD may be avoided or denied because of the high surgical morbidity and mortality reported in elderly patients. A recent meta-analysis of 10 publications from 2001 to 2011 showed an overall mortality rate of 36.7% (111/308) in octogenarians, a 2.6-fold higher mortality risk than that in younger patients. 11 In contrast, some reports have demonstrated satisfactory surgical outcomes of AAD in octogenarians. 12-15 A recent report also demonstrated that although the number of surgical deaths significantly increased with increased age, it was still better than that with non-surgical Background: Because increased age is a strong independent predictor of mortality and morbidity, surgery for octogenarians with Stanford type A aortic dissection (AAD) may be avoided.

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“…Since 2001, several studies [4][5][6][7][8][9][10]14,15 have reported outcomes for the surgical treatment of AAD (A) in octogenarians. Reports from 2001 to 2009 found unsatisfactory survival rates, ranging from 45.5% to 83.3%, for octogenarians after surgery for AAD (A), and significantly higher in-hospital mortality for octogenarians than for younger patients.…”

Section: Thirty-day Mortalitymentioning

confidence: 99%

“…The preoperative clinical severity, including such factors as shock, CPA, or malperfusion syndrome, deeply affects the morbidity and mortality after surgical treatment for AAD (A). 16,17 El-Sayed Ahamed et al 15 reported a 30day mortality of 26% in 39 octogenarians surgically treated for AAD (A); these patients included 7 cases (18%) of shock, 7 (18%) with malperfusion, and 2 (5%) with CPA. Tang et al 10 reported excellent surgical outcomes in 21 octogenarians with AAD (A); however, their report included only 2 cases (9.5%) of shock, 1 (4.8%) with malperfusion, and none with CPA.…”

Section: Preoperative Patient Statusmentioning

confidence: 99%

“…20 In recent reports of AAD (A) in octogenarians, Rylski and colleagues 14 reported 8 patients (9.4%) who were treated by total arch replacement and 11 (13.3%) by aortic root surgery, with a 30-day mortality of 34.9%. El-Sayed Ahamed and colleagues 15 reported 7 cases (18%) of total arch replacement and 8 (21%) of aortic root surgery, with a 30-day mortality of 26%. However, Hata and colleagues 9 reported 27 AAD FIGURE 2.…”

Section: Surgical Procedures In Octogenariansmentioning

confidence: 99%

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Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians

Kondoh

Satoh

Daimon

et al. 2016

The Journal of Thoracic and Cardiovascular Surgery

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Surgical Repair for Acute Type A Aortic Dissection in Octogenarians

Cited by 27 publications

References 31 publications

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

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

Early and Late Outcomes of Surgical Repair for Stanford A Acute Aortic Dissection in Octogenarians

Outcomes of limited proximal aortic replacement for type A aortic dissection in octogenarians

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