Operation for acute type A aortic dissection in octogenarians: Is it justified?

Neri, Eugénio; Toscano, Thomas; Massetti, Massimo; Capannini, Gianni; Carone, Enrico; Tucci, Enrico; Diciolla, Francesco; Scolletta, Sabino; Morello, Rémy; Sassi, Carlo

doi:10.1067/mtc.2001.112205

Cited by 121 publications

(69 citation statements)

References 7 publications

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“…102,103) With improved surgical outcomes, however, the issue has recently shifted to surgeries on AAAD patients over 80 years old. [104][105][106] Hata et al have devised "less invasive quick replacement (LIQR)" using distal anastomosis at a rectal temperature of 28 degrees without cerebral perfusion, followed by rapid warming with a heating mat and circulating blood at 40 degrees, achieving improved outcomes in elderly patients. 107) Rylski et al surveyed 381 septuagenarians and 83 octogenarians or older and reported that the former had acceptable mortality (30-day mortality of 16%) but the latter had higher mortality (35%).…”

Section: Age and Indication For Surgical Treatmentmentioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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Despite improved outcomes of acute type A aortic dissection (AAAD), many patients die at the moment of onset, and hospital mortality is still high. This article reviews the latest literature to seek the best possible way to optimize outcomes. Delayed diagnosis is caused by variation in or absence of typical symptoms, especially in patients with neurological symptoms. Misdiagnosis as acute myocardial infarction is another problem. Improved awareness by physicians is needed. On arrival, quick admission to the OR is desirable, followed by assessment with transesophageal echocardiography, and malperfusion already exists or newly develops in the OR; thus, timely diagnosis without delay with multimodality assessment is important. Although endovascular therapy is promising, careful introduction is mandatory so as not to cause complications. While various routes are used for the systemic perfusion, not a single route is perfect, and careful monitoring is essential. Surgical treatment on octogenarians is increasingly performed and produces better outcomes than conservative therapy. Complications are not rare, and consent from the family is essential. Prevention of AAAD is another important issue because more patients die at its onset than in the following treatment. In addition to hereditary diseases, including bicuspid aortic valve disease, the management of blood pressure is important.Keywords: aortic dissection, malperfusion, complication, echocardiography A cute type A aortic dissection (AAAD) not only causes sudden death at the time of onset but leads to various life-threatening complications. In spite of improved diagnostic imaging and surgical strategies, in-hospital mortality is still high, and patients who have survived often suffer from sequelae that make subsequent quality of life poor. This article is aimed to review the latest literature and ideas to seek the best possible way to minimize undesirable results.Various complications of AAAD caused by separation of the aortic wall to outer and inner layers are summarized as three categories: 1) aortic rupture due to disruption of the outer layer; 2) malperfusion caused by the inner layer, that is, the intimal flap; and 3) aortic regurgitation by a deformed aortic valve, leading to acute heart failure. Approximately 20% of patients instantaneously die due to aortic rupture, 1) and 1 to 2% of the remaining patients die every hour unless appropriately treated. 2) Although surgical outcomes are gradually improving, in-hospital mortality of surgical patients (repair on the aortic root to the arch) in 2009 was as high as around 10%, according to the Japanese database. 3) For the further improvement of outcomes, problems should be solved in each of preonset, pre-hospital, and in-hospital stages. In this review, the latter two stages are discussed first, since most of the literature focuses on these stages. After that, the issue of pre-onset stage, i.e., prevention is discussed. DelayeD DiagnosisIn consideration of the natural history of AAAD, the "chain of onset-to-sur...

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Section: Age and Indication For Surgical Treatmentmentioning

confidence: 99%

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Orihashi¹

2012

Annals of Vascular Diseases

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“…46,157-161 The in-hospital mortality rate of acute type A dissection surgery has recently improved to about 10% in Japan. Listed risk factors for surgical death in patients with acute type A aortic dissection include advanced age (80 years or older), 162 preoperative shock, malperfusion of the vital organs, 163 preoperative brain damage, and massive bleeding during surgery.…”

Section: (3) Therapeutic Resultsmentioning

confidence: 99%

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

Group¹

2013

Circ J

257

101

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“…On the contrary, higher morbidity and mortality has been observed in high-risk combined procedures, 7) reoperations, 8) and acute aortic surgery. 9) Most of these studies examined postoperative outcome of distinct surgical procedures without special attention to overall perioperative risk. However, in our routine practice, we often assess octogenarians with many comorbidities, in whom the type of surgery constitutes only a part of the overall risk.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational Retrospective Study

Pořízka

Kunstýř

Vanek

et al. 2017

ATCS

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Purpose: Cardiac surgery in octogenarians with severely deteriorated functional status is increasingly common, but outcome data are still limited. The aim of this study was to compare postoperative outcome, survival, and quality of life of low-, medium-, and highrisk octogenarians undergoing cardiac surgery. Methods: In all, 285 Czech octogenarians who underwent any cardiac surgical procedure between January 2011 and December 2012 were included in the study. Five out of all twelve national adult cardiac surgical centers participated in the study, representing almost half of all octogenarians operated in our country in that period. Patients' perioperative data were analyzed retrospectively. Follow-up was performed by interviewing patients by telephone. Results: There was higher 30-day mortality (20% vs. 6.4% vs. 5.2%, respectively, p <0.001), lower 2-year survival (60% vs. 84.0% vs. 85.4%, respectively, p <0.05), and lower Karnofsky score (44.4 vs. 70.1 vs. 70.6, respectively, p <0.001) in high-risk group compared with medium-and low-risk groups, respectively. Greater improvement in New York Heart Association (NYHA) status was noted in high-and medium-risk groups compared with low-risk group (51% vs. 45% vs. 24%, respectively, p <0.05). Conclusion: High perioperative mortality, poor 2-year survival, and low postoperative quality of life have been observed in high-risk octogenarians undergoing cardiac surgery.

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Operation for acute type A aortic dissection in octogenarians: Is it justified?

Cited by 121 publications

References 7 publications

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Acute Type A Aortic Dissection: for Further Improvement of Outcomes

Guidelines for Diagnosis and Treatment of Aortic Aneurysm and Aortic Dissection (JCS 2011)

Postoperative Outcome of High-Risk Octogenarians Undergoing Cardiac Surgery: A Multicenter Observational Retrospective Study

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