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

Background. The number of elderly patients undergoing emergency operation for acute type A aortic dissection is increasing in the aging society. We examined the early and late outcomes of operation for acute type A aortic dissection in elderly patients (>= 80 years old). Methods. From January 2001 to December 2015, 345 consecutive patients underwent surgical treatment for acute type A aortic dissection at our institution. Of these, 63 elderly patients (>= 80 years old; 28 men; mean age, 83.7 +/- 3.0 years) were reviewed and compared with nonelderly patients (<= 79 years old). Results. The hospital death was 9/63 (14.3%) and 25/282 (8.9%) in patients 80 years and older but 79 years or younger, respectively (p = 0.28). Multivariate analysis showed age 80 years or older was a significant risk factor for hospital mortality (odds ratio 3.27, 95% confidence interval: 1.22 to 8.76, p = 0.02). During follow-up period (mean, 51.3 +/- 40.9 months; range, 1 to 162 months), the 5year survival of the elderly patients discharged from the hospital was 58.6% +/- 8.7%. At postoperative 6 months and the latest follow-up (mean, 44.3 +/- 25.6 months) of the elderly patients excluding late death, 90.2% (46/51) and 88% (22/25) of elderly patients had totally or almost independent daily life, respectively. Conclusions. Although age 80 years or older was the risk factor for hospital mortality in operation for acute type A aortic dissection, the long-term survival of the hospital survivors and the level of activity of daily life were acceptable. Aggressive surgical treatment could be a reasonable option for selected elderly patients. (C) 2017 by The Society of Thoracic Surgeons