Is Surgical Treatment of Acute Type A Dissection in Patients Over 80 Years of Age Even Justified?

Background: Type A dissection is an acutely life-threatening disease with a high, age-related in-hospital lethality.

Methods: We report on 416 patients who received surgery for type A dissection in the period from 2011 to 2024. In this retrospective study we classified our patients according to age decades and analyzed the primary endpoint death during hospitalization in our clinic.

Results: The average age was 63.6 (±13.1) years; the proportion of male patients was 62.5%. The EuroSCORE II had a mean value of 7.2%, being highest (15.1%) in the oldest age group of patients over 80 years. 8.7% of the patients received an isolated replacement of the ascending aorta. A combination with a partial aortic arch procedure was necessary in 39.2%. Replacement of the ascending aorta in combination with a total aortic arch replacement was performed in 27.4%. Of these 53.5% were treated with a conventional elephant trunk (CET), and in 46.5% a frozen elephant trunk was implanted (FET). In 3.8% of all cases, an additional aortic valve replacement was indicated. Aortic root replacement was performed in 18.5% of all patients. The average ECC time was 205.6 (±77.4) minutes, and the aortic clamping time was 119.3 (±50.6) minutes. The mean duration of the circulatory arrest was 35.3 (±27.5) minutes. The median ventilation time was 12 hours (0/1453). The average duration of the postoperative stay in intensive care unit was 3.9 (±6.8) days. The mean length of stay in our institution was 16.0 (±13.3) days. 21.4% required dialysis postoperatively, 23.7% in the highest age group. 19.2% of patients were discharged with neurological symptoms resulting from stroke. Overall lethality in our clinic was 19.7%; in the octogenarians it was 36.8%. The number of surviving octogenarians without a neurological deficit at the time of discharge was 39.5%.

Conclusion: In patients over 80 years of age, the lethality in our clinic was higher and the postoperative clinical outcome at the time of discharge was worse compared with all other age groups. The age at the time of the operation should always be considered in the process of indicating surgery, but it alone should not be an exclusion criterion. Further studies are necessary evaluating the impact of pre-existing conditions and comorbidities on survival of older patients. However, it should be noted that the proportion of surviving patients over 80 years of age who did not have neurological deficits at the time of discharge from hospital was significantly lower than in all other age groups.

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Artikel online veröffentlicht:
11. Februar 2025