Early and late outcomes after acute type-A aortic dissection in patients under 45 and over 80 years old. Preliminary data on 989 cases at a single institution

Objectives: Since acute type-A aortic dissection is associated with extremely high mortality this condition is now considered an emergency indication for surgery. At our institution no patients are excluded from immediate operation irrespective of age and preoperative status unless uncontrollable hemorrhage and/or cardiac arrest occur before the patient reaches the operating room. In this preliminary study, which is part of a concise data analysis, early and late outcome of two groups (<45 years and ≥80 years old) were compared.

Methods: Between 09/1986 and 05/2011, 989 patients (679 men) with a mean age of 58.7±11 (range 16–92) years underwent surgery for acute type-A aortic dissection. The patientswere grouped as those aged <45 years (n=163; mean age, 37.1 years; younger group) and those aged ≥80 years (n=55; mean age, 83.3 years; older group). In the younger group most of the patients had aortic valve and ascending aorta composite replacement (55% vs. 9%). In most cases hypothermic circulatory arrest was induced to allow open inspection of the aortic arch and its repair when indicated.

Results: The 30-day mortality was for all patients 28% (17.1% for the younger group and 38.1% for older group), which dropped significantly from 52% in the first 10 years to 18% in the last 10 years. The following were significantly more prevalent in the younger group: Marfan syndrome (20.8% vs. 0%), aortic regurgitation (61.3% vs. 21.8%) and male sex (76% vs. 34.5%). The cumulative survival rate at 1, 5 and 10 years was 76.1%±3.4, 53.0%±5.3 and 53.0%±5.3 in the younger group, and at 1 and 5 years 52.7%±6.7 and 42.4±7.2 in the older group (P<0.001), respectively.

Conclusions: Emergency surgery for acute type-A dissection is associated with relatively high mortality which is influenced by institutional experience and patients' preoperative condition. Although in younger patients more complex surgery was performed, the early and late mortality is lower in these patients than in those over 80 years of age. However, the results in older patients are satisfactory and no patient should be excluded from operation when he or she can reach the operating room alive.