Document Detail


Is advanced age a contraindication for emergent repair of acute type A aortic dissection?
MedLine Citation:
PMID:  20093267     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
With the general increase in human lifespan, cardiac surgeons are faced with treating an increasing number of elderly patients. The aim of our study was to investigate whether advanced age poses an increased risk for major morbidity and mortality with repair of acute type A aortic dissection. Between 2000 and 2008, 119 patients underwent emergency operation for acute type A aortic dissection at two institutions; 90 were younger than 70 years of age and 29 patients were 70 years or older. Major morbidity, operative and 5-year actuarial survival were compared between groups. The operative mortality rates were comparable between the two groups (18.9% in patients <70 years vs. 24.1% for patients >or=70 years, P=0.6). There was no difference in the rates of reoperation for bleeding (<70 years 31.7% vs. 14.3% for >or=70 years, P=0.09), stroke (18.9% for those <70 years vs. 20.7% for those >or=70 years, P=0.79), acute renal failure (22.2% for those <70 years vs. 17.2% for those >or=70 years, P=0.79) or prolonged ventilation (34.4% for those <70 years vs. 24.1% for those >or=70 years, P=0.36) between the two groups. Actuarial 5-year survival rates were 77% for patients <70 years vs. 59% for patients >or=70 years (P=0.07). The mortality for patients who presented with hemodynamic instability was markedly higher (10 out of 14 patients, 71.4%) compared with the mortality of those who presented with stable hemodynamics (21 out of 88 patients, 23.9%, P<0.001), regardless of age group. No significant differences in operative mortality, major morbidity and actuarial 5-year survival were observed between patients >or=70 years and younger patients although there was a trend toward a lower actuarial 5-year survival in older patients. Surgery for type A acute aortic dissection in patients 70 years or older can be performed with acceptable outcomes. Hemodynamic instability portends a poor prognosis, regardless of age.
Authors:
Sotiris C Stamou; Robert C Hagberg; Kamal R Khabbaz; Mark R Stiegel; Mark K Reames; Eric Skipper; Marcy Nussbaum; Kevin W Lobdell
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Publication Detail:
Type:  Comparative Study; Journal Article; Multicenter Study     Date:  2010-01-21
Journal Detail:
Title:  Interactive cardiovascular and thoracic surgery     Volume:  10     ISSN:  1569-9285     ISO Abbreviation:  Interact Cardiovasc Thorac Surg     Publication Date:  2010 Apr 
Date Detail:
Created Date:  2010-03-25     Completed Date:  2010-06-10     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101158399     Medline TA:  Interact Cardiovasc Thorac Surg     Country:  England    
Other Details:
Languages:  eng     Pagination:  539-44     Citation Subset:  IM    
Affiliation:
Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
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MeSH Terms
Descriptor/Qualifier:
Acute Disease
Adult
Age Factors
Aged
Aged, 80 and over
Aneurysm, Dissecting / mortality,  physiopathology,  surgery*
Aortic Aneurysm / mortality,  physiopathology,  surgery*
Chi-Square Distribution
Emergency Treatment
Female
Hemodynamics
Humans
Kaplan-Meiers Estimate
Kidney Failure, Acute / etiology
Male
Middle Aged
Patient Selection
Postoperative Hemorrhage / etiology,  surgery
Reoperation
Respiration, Artificial
Retrospective Studies
Risk Assessment
Risk Factors
Stroke / etiology
Time Factors
Treatment Outcome
United States / epidemiology
Vascular Surgical Procedures / contraindications*,  mortality
Young Adult

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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