Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians

Kawahito, Koji; Kimura, Naoyuki; Yamaguchi, Atsushi; Aizawa, Kei; Misawa, Yoshio; Adachi, Hideo

doi:10.1016/j.athoracsur.2017.06.057

Cited by 41 publications

(41 citation statements)

References 17 publications

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“…Although several studies have reported operative outcomes in patients aged > 80 years, no study has reported findings in nonagenarians. [2][3][4][5][6][7][8] Despite the low statistical power of this study, a significant intergroup difference was observed in survival curves (Figure 2). This finding supports the indication for open surgical aortic repair in nonagenarians.…”

Section: Discussionmentioning

confidence: 70%

“…However, Kawahito and colleagues 6 noted the existence of a selection bias in octogenarians, because patients in a poor state of health are at high risk of mortality without surgical intervention. Considering the results of the study by Kawahito and colleagues, 5 Tang and colleagues 6 reported the feasibility of surgery for TAAD in octogenarians. In the current era, it is not uncommon to perform surgery (elective or emergency) on patients in their 80s.…”

Section: Discussionmentioning

confidence: 99%

“…Careful consideration of surgical indications is important prior to performing open surgical repair in nonagenarians; identification of high-risk patients is essential. Kawahito and colleagues 6 reported that frailty independently predicts surgical outcomes in older patients. In our study, we observed that the number of patients performing ADL independently was significantly lower in the nonsurgical group than in the surgical group, and the clinical frailty scale was significantly higher in the nonsurgical group than in the surgical group (Table 1).…”

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

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Background Decision-making regarding the operability of thoracic aortic disease in nonagenarian patients remains controversial because outcomes of open surgical repair of the thoracic aorta are unclear. We investigated the surgical and nonsurgical outcomes of acute thoracic aortic syndrome treatment in nonagenarians. Methods After evaluating data in our institute from April 2016 to March 2020, we included 10 nonagenarians who needed surgical intervention on the thoracic aorta via a median sternotomy for acute thoracic aortic syndrome. The mean age of the cohort was 91.9 ± 2.1 years. Five patients underwent open surgical repair of the thoracic aorta (surgical group), and 5 refused surgery (nonsurgical group). All patients in the surgical group performed activities of daily living independently, with a mean clinical frailty scale of 3.2 ± 0.4. The surgical group included 4 patients with type A aortic dissection and one with a ruptured thoracic aortic aneurysm. Hemiarch replacement was performed in 3 patients and total arch replacement in 2. The mean follow-up period was 17.8 ± 5.1 months. Results Hospital mortality rates were 0% in the surgical and 80% in the nonsurgical group. The mean length of hospitalization was 28.4 ± 6.7 days in the surgical group. The 1-year survival rates were 100% in the surgical group and 20% in the nonsurgical group. Conclusion Open surgical repair for acute thoracic aortic syndrome via median sternotomy is a reasonable treatment option even in nonagenarians. Involvement of family members is important for decision-making to devise the optimal treatment strategy (surgical vs. medical).

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Section: Discussionmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Arakawa¹,

Okamura²,

Miyagawa³

et al. 2020

Asian Cardiovasc Thorac Ann

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“…Although this study cohort was small, their analysis indicates more favorable outcomes for patients treated surgically (postoperative mortality rate: surgical treatment, 25.2%; non-surgical treatment, 59.0%). Furthermore, postoperative mortality of AAD surgery in the elderly in some reports from Japan is generally low (3.7–13.6%) and favorable, although their age definition of ‘elderly’ varies from 70 to 80 years of age [16–22]. Despite these favorable reports, our survey indicates that only half of the elderly patients with AAD (80 years or older) are treated surgically.…”

Section: Discussionmentioning

confidence: 71%

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Aoyama

Kunisawa

Fushimi

et al. 2018

J Cardiothorac Surg

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BackgroundIn recent years, surgical outcomes have improved, and positive reports on surgery for type A aortic dissection (AAD) in the elderly are increasing. However, the difference between surgical and conservative treatments in the elderly remains unclear. Therefore, we conducted this study to determine whether surgery should be performed for Stanford (AAD) in elderly patients.MethodsData of patients aged 80 years or older who were hospitalized for AAD from April 2014 to March 2016 were extracted from the Japanese national inpatient database. Outcome measures were all-cause in-hospital death, stroke, acute kidney injury and tracheotomy, and composite adverse events (consisting of all-cause in-hospital death, stroke, acute kidney injury, and tracheotomy), and we compared them between surgical and conservative treatments using propensity score matching.ResultsThe study cohort included 3258 patients, with 845 matched pairs (1690 patients) in the propensity score matching. All-cause in-hospital death was significantly lower in the surgical treatment group than in the conservative treatment group before and after matching (15.6% vs. 51.1%, p < 0.001; 16.7% vs. 31.6%, p < 0.001, respectively); however, there was no significant difference in composite adverse events after matching (36.0%, conservative vs. 37.2%, surgical; p = 0.65), and adjusted odds ratio was 1.06 and 95% confidence interval was 0.86–1.29 (p = 0.61) with reference to conservative treatment.ConclusionsAll-cause in-hospital death among elderly patients with AAD was significantly lower in patients treated surgically than in those undergoing conservative treatment. However, there was no significant difference between the two groups in the event-free survival, which is important for the elderly. These findings may be used in the consideration of treatment course for elderly patients with AAD.Electronic supplementary materialThe online version of this article (10.1186/s13019-018-0814-6) contains supplementary material, which is available to authorized users.

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“…Being overweight was associated with early mortality as stated in a Chinese study by Ma et al [ 5 ] . Interestingly, another Western study demonstrated that obesity (BMI > 30 kg/m 2 ) is significantly related to early mortality in AAAD patients [ 15 ] .…”

Section: Discussionmentioning

confidence: 99%

Early Mortality in Patients who Received Extensive Surgical Management for Acute Type A Aortic Dissection – Analysis of 452 Consecutive Cases from a Single-center Experience

Abdelhameed¹,

Xiao²,

Wei³

2020

Braz J Cardiovasc Surg

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Objective To detect the potential risk factors associated with early mortality in patients who received extensive surgical management, in the form of total arch replacement plus frozen elephant trunk and arch debranching (hybrid repair technique), for acute type A aortic dissection. Methods The clinical and surgical data of 452 surgically treated patients with acute type A aortic dissection at our center, between March 2010 and December 2016, have been retrieved. Uni and multivariate logistic regression analyses were carried out to detect the effect of various preoperative demographics and different perioperative variables on early mortality. Results Overall 30-day mortality occurred in 70 out of 452 patients (15.4%). The principal causes of death were multiple organ failure (n=38), cardiac failure (n=18), and severe pulmonary infection (n=10). Risk factors for early mortality were identified with multivariate analysis. Preoperatively, overweight ( P <0.025), alcohol drinking ( P <0.002), coronary artery disease ( P <0.014), hemodynamic shock ( P <0.006), and elevated white blood cells count ( P <0.002) were associated with higher mortality rate. Postoperatively, prolonged operation time ( P <0.008), stroke ( P <0.0001), and acute renal dysfunction ( P <0.0001) were highly associated with death. Conclusion Considering the advantages of extensive surgical management for acute type A aortic dissection over the other less aggressive surgical approaches, it should be advised whenever indicated, provided that being carried out by experts in the field of adult aortic surgery in high-volume centers. The surgeon should be aware of the patient’s preoperative comorbidities and other risk factors for early mortality, in particular, prolonged operation time.

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Early and Late Surgical Outcomes of Acute Type A Aortic Dissection in Octogenarians

Abstract: No significant difference in the hospital mortality rate or the complication rate was observed between the groups. Emergency surgery for ATAAD in octogenarians could be performed with the same low risk observed for younger patients.

Cited by 41 publications

References 17 publications

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Clinical outcome of acute thoracic aortic syndrome in nonagenarians

Comparison of surgical and conservative treatment outcomes for type a aortic dissection in elderly patients

Early Mortality in Patients who Received Extensive Surgical Management for Acute Type A Aortic Dissection – Analysis of 452 Consecutive Cases from a Single-center Experience

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