Management of acute type A aortic dissection in the elderly: an analysis from IRAD

• Published in: European journal of cardio-thoracic surgery Vol. 61; no. 4; pp. 838 - 846
• Main Authors: Hemli, Jonathan M, Pupovac, Stevan S, Gleason, Thomas G, Sundt, Thoralf M, Desai, Nimesh D, Pacini, Davide, Ouzounian, Maral, Appoo, Jehangir J, Montgomery, Daniel G, Eagle, Kim A, Ota, Takeyoshi, Di Eusanio, Marco, Estrera, Anthony L, Coselli, Joseph S, Patel, Himanshu J, Trimarchi, Santi, Brinster, Derek R
• Format: Journal Article
• Language: English
• Published: Germany Oxford University Press 24-03-2022
• Subjects: Age Factors; Aged; Aged, 80 and over; Aneurysm, Dissecting; Hospital Mortality; Humans; Postoperative Complications - epidemiology; Registries; Retrospective Studies; Risk Factors; Treatment Outcome; Aortic dissection; Octogenarian; Elderly; Septuagenarian
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1093/ejcts/ezab546

Abstract
OBJECTIVES
We sought to examine management and outcomes of (Stanford) type A aortic dissection (TAAAD) in patients aged >70 years.
METHODS
All patients with TAAAD enrolled in the International Registry of Acute Aortic Dissection database (1996–2018) were studied (n = 5553). Patients were stratified by age and therapeutic strategy. Outcomes for octogenarians were compared with those for septuagenarians. Variables associated with in-hospital mortality were identified by multivariable logistic regression.
RESULTS
In-hospital mortality for all patients (all ages) was 19.7% (1167 deaths), 16.1% after surgical intervention vs 52.1% for medical management (P < 0.001). Of the study population, 1281 patients (21.6%) were aged 71–80 years and 475 (8.0%) were >80 years. Fewer octogenarians underwent surgery versus septuagenarians (68.1% vs 85.9%, P < 0.001). Overall mortality was higher for octogenarians versus septuagenarians (32.0% vs 25.6%, P = 0.008); however, surgical mortality was similar (25.1% vs 21.7%, P = 0.205). Postoperative complications were comparable between surgically managed cohorts, although reoperation for bleeding was more common in septuagenarians (8.1% vs 3.2%, P = 0.033). Kaplan–Meier 5-year survival was significantly superior after surgical repair in all age groups, including septuagenarians (57.0% vs 13.7%, P < 0.001) and octogenarians (35.5% vs 22.6%, P < 0.001).
CONCLUSIONS
When compared with septuagenarians, a smaller percentage of octogenarians undergo surgical repair for TAAAD, even though postoperative outcomes are similar. Age alone should not preclude consideration for surgery in appropriately selected patients with TAAAD.
Despite reports that continue to demonstrate improvement, surgical mortality in (Stanford) type A acute aortic dissection (TAAAD) remains substantial [1, 2].