Midterm Outcomes of Rapid, Minimally Invasive Resection of Acute Type A Aortic Dissection in Octogenarians

Background. We previously reported the development of a new surgical technique, called the "less invasive quick replacement" technique, for treating type A acute aortic dissection. This study examines the midterm outcome and postoperative quality of life of octogenarian patients who underwent less invasive quick replacement. Methods. During the last 3 years, 27 patients underwent less invasive quick replacement. The average age of the patients at the time of onset was 81.7 years old. During open distal anastomosis with a rectal temperature of 28 degrees C without any cerebral perfusion, circulating blood in the cardiopulmonary bypass circuit was warmed to 40 degrees C. As soon as the distal anastomosis was completed, rapid rewarming was initiated by 40 degrees C blood perfusion. We assessed the midterm outcomes in terms of survival and cardiovascular event-free rates, patency of the distal false lumen, aortic regurgitation, and cognitive disorders. Results. The durations of circulatory arrest, cardiopulmonary bypass, overall operation, postoperative mechanical ventilation, and hospital stay were 18.7 minutes, 82.8 minutes, 143.4 minutes, 13.0 hours, and 12.2 days, respectively. Hospital mortality rate was 3.7% (1 patient). There were no incidences of brain damage, renal failure, or respiratory failure. At the time of this study, 25 of the patients were doing well and visiting the outpatient clinic, and 22 of them scored more than 20 points on the Mini-Mental State Examination, indicating no development of dementia. Midterm computed tomography scans detected the patent false lumen in 11.5%. No aortic regurgitation was found in the echocardiography. Actuarial survival and cardiovascular event-free rates at 3 years were 96.2% and 83.0%, respectively. Conclusions. The less invasive quick replacement technique is safe and effective. It is a very attractive option that can contribute to maintaining a long-term good quality of life for octogenarians with type A acute aortic dissection. (Ann Thorac Surg 2010; 89: 1860-5) (C) 2010 by The Society of Thoracic Surgeons