HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Francesco Santini Antonio Messina Augusto D’Onofrio Gianluca Casali Francesca Viscardi Giovanni Battista Luciani Alessandro Mazzucco Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Santini, F. Articles by Mazzucco, A. Search for Related Content PubMed PubMed Citation Articles by Santini, F. Articles by Mazzucco, A. Related Collections Cardiac - other Great vessels Valve disease

Eur J Cardiothorac Surg 2006;29:386-391
© 2006 Elsevier Science NL

Survival and quality of life after repair of acute type A aortic dissection in patients aged 75 years and older justify intervention

Division of Cardiac Surgery, University of Verona, OCM Borgo Trento, Piazzale Stefani 1, 37126 Verona, Italy

Received 13 September 2005; received in revised form 7 December 2005; accepted 13 December 2005.

^_* Corresponding author. Tel.: +39 045 8072476; fax: +39 045 8073308. (Email: fsant{at}yahoo.com).

Objective: Controversy still exists about averting expenditure of health care resources on the growing elderly population. This study evaluates clinical outcome of patients aged 75 years and older operated upon for acute type A aortic dissection. Methods: Between January 1990 and April 2004, of 247 patients undergoing emergency operation for acute type A aortic dissection at our Institution, 40 patients (16%) were aged 75 years and older (mean 78 ± 3 years, range 75–88 years) and represent the study population. On admission, 9 (22.5%) had cardiogenic shock/hypotension, 20 (50%) cardiac tamponade, 14 (35%) kidney failure, 11 (27.5%) limb ischemia, 3 (7.5%) neurologic deficit, and 1 (2.5%) myocardial ischemia. Surgical procedures included isolated replacement of the ascending aorta in 34 patients (85%), associated with total root replacement in 5 (12.5%), and with aortic valve replacement in 1 (2.5%). Eleven patients (27.5%) underwent aortic arch replacement (hemiarch: n = 8, 20%; total arch: n = 3, 7.5%). Results: In-hospital mortality was 30% (12 patients). Mortality tended to be higher (8/21, 38% vs 4/19, 21%; p = NS) for patients presenting with any one of the following complications: tamponade, shock, brain and/or myocardial, renal, limb malperfusion. Actuarial survival at 1, 5, and 7 years was 93 ± 5%, 80 ± 8%, and 80 ± 8%, respectively, and freedom from reoperation 97 ± 2%, 97 ± 2%, and 97 ± 2%, respectively. Actuarial event-free rates were 94 ± 3%, 90 ± 5%, and 90 ± 5%. Seventy-four percent of survivors are in NYHA FC I, and quality of life test (RAND SF-36) revealed a generalized perception of independency and well-being, comparable to an age-matched population. Conclusions: Overall results for emergency repair of acute type A aortic dissection in the elderly justify intervention, particularly in uncomplicated cases. Expeditious referral and intervention by lowering pre-operative dissection-related complications and comorbidities might help to improve results. Survivors show functional status and quality of life similar to contemporary individuals.

Key Words: Aortic dissection • Mortality • Elderly • Quality of life

This article has been cited by other articles:

				M. Shrestha, N. Khaladj, A. Haverich, and C. Hagl Is Treatment of Acute Type A Aortic Dissection in Septuagenarians Justifiable? Asian Cardiovasc Thorac Ann, February 1, 2008; 16(1): 33 - 36. [Abstract] [Full Text] [PDF]

				M. Ates Which suture technique is better in acute type A aortic dissection? Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 199 - 199. [Full Text] [PDF]

				F. Santini and A. Mazzucco Reply to ates. Eur. J. Cardiothorac. Surg., July 1, 2006; 30(1): 199 - 200. [Full Text] [PDF]