Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians

Commentary: Acute type A aortic dissection: When sample size does matter

“…In this issue of Journal, Bojko et coll. give their contribute to the questions concluding that early and midterm survival and quality of life after surgery for ATAAD are similar in octogenarians and septuagenarians [5]. Furthermore, octogenarians who survive at initial operation have comparable long-term survival to an age and sex matched population.…”

Emergency surgery for Type A Aortic Dissection in Octogenarians -- do we still err on the side of caution?

“…Octogenarians with ATAAD present with a wide range of clinical presentations and comorbidities, which will dictate the risk of the surgery along with their age, further causing controversy among the decision to operate and the assessment of risk vs benefits. The study by Bojko et al of 70 octogenarian's vs 165 septuagenarians reported no difference in 30-day survival risk (28.6% vs 21.2%, p=0.29), and no difference in the survival until 4 years after the surgery (p=0.07), after which the septuagenarians showed greater survival benefit 4 . In our experience, outcomes for octogenarians who have experienced complex aortic surgery that included a period of deep hypothermic circulatory arrest (DHCA) were severely impacted 5 .…”

“…We note that the conservative approach used by Chen et al was most effective in reducing post-operative complications, with 81.7% of all surgical octogenarians being discharged alive and well, defined as a clinical status free from tracheostomy, permanent dialysis, and severe neurologic dysfunction at discharge. This can be compared to 32.0% of octogenarians being discharged home post-operatively in the cohort analysed by Bojko et al 4 In this patient population, even a successful surgery can often lead to a series of severe cerebrovascular or bleeding-related complications, which are avoided by restricting usage of intensive operative methods and techniques.…”

Emergency surgery for type A aortic dissection in octogenarians—Do we still err on the side of caution?

“…The study by Bojko et al of 70 octogenarian's versus 165 septuagenarians reported no difference in 30-day survival risk (28.6% vs. 21.2%, p = .29), and no difference in the survival until 4 years after the surgery (p = .07), after which the septuagenarians showed greater survival benefit. 4 In our experience, outcomes for octogenarians who have experienced complex aortic surgery that included a period of deep hypothermic circulatory arrest (DHCA) were severely impacted. 5 Out of the 457 patients (24 octogenarians) who underwent a period of DHCA, elective in-hospital mortality and stroke rates were higher (16.7% and 22.2%).…”

“…2022;37:616-617. wileyonlinelibrary.com/journal/jocs 616 | © 2022 Wiley Periodicals LLC 81.7% of all surgical octogenarians being discharged alive and well, defined as a clinical status free from a tracheostomy, permanent dialysis, and severe neurologic dysfunction at discharge. This can be compared to 32.0% of octogenarians being discharged home postoperatively in the cohort analyzed by Bojko et al 4 In this patient population, even a successful surgery can often lead to a series of severe cerebrovascular or bleeding-related complications, which are avoided by restricting usage of intensive operative methods and techniques.…”