Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation
| Autor: | Thierry Caus, Matthias Kirsch, Tommaso Regesta, Frederic Collart, Konstantinos Zannis, Marc Laskar, Vlad Gariboldi, Michel Tapia, Alessandro Piccardo, Elisabeth Cornu, Alexandre Le Guyader |
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| Jazyk: | angličtina |
| Rok vydání: | 2013 |
| Předmět: |
Male
Pulmonary and Respiratory Medicine medicine.medical_specialty Time Factors Multivariate analysis medicine.medical_treatment Risk Assessment Standard procedure Blood Vessel Prosthesis Implantation Postoperative Complications medicine Humans aorta dissection aged Hospital Mortality Registries Survivors Cardiopulmonary resuscitation Geriatric Assessment Retrospective Studies Ultrasonography Aged 80 and over Aortic dissection Analysis of Variance Aortic Aneurysm Thoracic business.industry medicine.disease Surgery Survival Rate Aortic Dissection Treatment Outcome Mesenteric ischemia Acute type Acute Disease Multivariate Analysis Female Emergencies Cardiology and Cardiovascular Medicine business Follow-Up Studies |
| Popis: | The management of acute type A aortic dissection (aTAAD) in octogenarian patients is controversial. This study analyzed the surgical outcomes to identify patients who should undergo operations.Beginning in January 2000, we established a registry including all octogenarian patients operated on for type A acute aortic dissection. We evaluated 79 consecutive patients enrolled up to December 2010. Their median age was 81.6 years (range, 80 to 89 years). Sixteen patients (20%) presented a complicated type because of a neurologic deficit, mesenteric ischemia, a requirement for cardiopulmonary resuscitation, or some combination of those features. Operations followed the standard procedure recommended for younger patients. Follow-up was 95% complete (mean, 4.6±2.8 years).The overall in-hospital mortality was 44.3%. The in-hospital mortality among patients with uncomplicated aTAAD was 33.3%. Multivariate analysis identified complicated aTAAD as the only risk factors for in-hospital mortality (p0.0001). Postoperative complications occurred in 50 patients (68.5%) and were associated with a higher mortality (p0.0001). The overall survival was 53% at 1 year and 32% at 5 years. In uncomplicated aTAAD, the overall survival was 63% at 1 year and 38% at 5 years.Octogenarians with uncomplicated aTAAD benefit from emergency surgical repair. In those patients, early and midterm outcomes are good and are similar to those in published series of younger patients. Complicated aTAAD should be medically managed. |
| Databáze: | OpenAIRE |
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