Survival after surgery for acute type A aortic dissection in octogenarians.

Antonio FIORE; Javier Rodriguez LEGA; Joscha BUECH; Giovanni MARISCALCO; Andrea PERROTTI; Konrad WISNIEWSKI; Angel G PINTO; Till DEMAL; Jan ROCEK; Petr KACER; Giuseppe GATTI; Igor VENDRAMIN; Mauro RINALDI; Eduard QUINTANA; Dario Di PERNA; Francesco NAPPI; Mark FIELD; Amer HARKY; Matteo PETTINARI; Angelo M DELL'AQUILA; Francesco ONORATI; Mikko JORMALAINEN; Tatu JUVONEN; Timo MÄKIKALLIO; Caroline RADNER; Sven PETERSS; Vito D'ANDREA; Fausto BIANCARI

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Survival after surgery for acute type A aortic dissection in octogenarians.

Author: Antonio FIORE ¹ ; Javier Rodriguez LEGA ² ; Joscha BUECH ³ ; Giovanni MARISCALCO ⁴ ; Andrea PERROTTI ⁵ ; Konrad WISNIEWSKI ⁶ ; Angel G PINTO ² ; Till DEMAL ⁷ ; Jan ROCEK ⁸ ; Petr KACER ⁸ ; Giuseppe GATTI ⁹ ; Igor VENDRAMIN ¹⁰ ; Mauro RINALDI ¹¹ ; Eduard QUINTANA ¹² ; Dario Di PERNA ¹³ ; Francesco NAPPI ¹⁴ ; Mark FIELD ¹⁵ ; Amer HARKY ¹⁵ ; Matteo PETTINARI ¹⁶ ; Angelo M DELL'AQUILA ¹⁷ ; Francesco ONORATI ¹⁸ ; Mikko JORMALAINEN ¹⁹ ; Tatu JUVONEN ¹⁹ ; Timo MÄKIKALLIO ²⁰ ; Caroline RADNER ³ ; Sven PETERSS ³ ; Vito D'ANDREA ²¹ ; Fausto BIANCARI ²²
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1. Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Creteil, France.
2. Cardiovascular Surgery Department, University Hospital Gregorio Marañón, Madrid, Spain.
3. LMU University Hospital, Ludwig Maximilian University, Munich, Germany.
4. Department of Cardiac Surgery, Glenfield Hospital, Leicester, United Kingdom.
5. Department of Thoracic and Cardiovascular Surgery, University of Franche-Comte, Besancon, France.
6. Department of Cardiothoracic Surgery, University Hospital Muenster, Muenster, Germany.
7. Department of Cardiovascular Surgery, University Heart and Vascular Center Hamburg, Hamburg, Germany.
8. Department of Cardiac Surgery, Charles University and University Hospital Kralovske Vinohrady, Prague, Czech Republic.
9. Division of Cardiac Surgery, Cardio-thoracic and Vascular Department, Azienda Sanitaria Universitaria Giuliano Isontina, Trieste, Italy.
10. Cardiothoracic Department, University Hospital, Udine, Italy.
11. Cardiac Surgery, Molinette Hospital, University of Turin, Turin, Italy.
12. Department of Cardiovascular Surgery, Hospital Clínic de Barcelona, University of Barcelona, Barcelona, Spain.
13. Department of Cardiac Surgery, Centre Hospitalier Annecy Genevois, Epagny Metz-Tessy, France.
14. Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France.
15. Liverpool Centre for Cardiovascular Sciences, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom.
16. Department of Cardiac Surgery, Ziekenhuis Oost Limburg, Genk, Belgium, and Département Cardiovasculair, Cliniques Universitaries Saint Luc, Bruxelles, Belgium.
17. Department of Cardiac surgery, Martin Luther University Halle-Wittenberg, Halle, Germany.
18. Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
19. Faculty of Medicine, University of Oulu, Oulu, Finland.
20. Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland.
21. Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy.
22. Department of Cardiovascular Surgery, Centro Cardiologico Monzino IRCCS, Milan, Italy.
Publication Type:Journal Article
From: Journal of Geriatric Cardiology 2024;21(11):1015-1025
CountryChina
Language:English
Abstract: OBJECTIVE:To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians.
METHODS:Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis.
RESULTS:326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%.
CONCLUSIONS:Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.