| Is advanced age a contraindication for emergent repair of acute type A aortic dissection? | |
MedLine Citation:
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PMID: 20093267 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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:
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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:
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Type: Comparative Study; Journal Article; Multicenter Study Date: 2010-01-21 |
Journal Detail:
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Title: Interactive cardiovascular and thoracic surgery Volume: 10 ISSN: 1569-9285 ISO Abbreviation: Interact Cardiovasc Thorac Surg Publication Date: 2010 Apr |
Date Detail:
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Created Date: 2010-03-25 Completed Date: 2010-06-10 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 101158399 Medline TA: Interact Cardiovasc Thorac Surg Country: England |
Other Details:
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Languages: eng Pagination: 539-44 Citation Subset: IM |
Affiliation:
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Division of Cardiothoracic Surgery, Department of Surgery and The Cardiovascular Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA. |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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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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