Influence of Age and the Burden of Ischemic Injury on the Outcome of Type A Aortic Dissection Repair.

Abstract

This study evaluated operative details and postoperative outcomes in elderly patients according to the burden of ischemic injury. Between 2002 and 2017, 1187 patients in 2 centers were operated on for aortic dissection type A (ADA). Patients were grouped according to the Penn classification: class A, 628 patients; class B, 196; class C, 224; and class BC, 139. The perioperative conditions and outcomes were analyzed. The likelihood of presenting in a Penn class changed significantly with age (P = .02). Also, the probability of ADA extension into the supraaortic vessels (P < .001) or the distal aorta (P < .001) decreased significantly over age. Nevertheless, there was no significant difference in the distal aortic repair between younger and older patients. The probability of in-hospital mortality increased significantly in all Penn classes with age (P < .001). Yet, predicted mortality remained below 15% for any age in class A patients but increased up to 25% in class B and C patients and beyond 50% in class BC patients. Class A or B were not predictive of in-hospital mortality in septuagenarians or octogenarians. Age by itself is not a rational criterion to select patients for surgical treatment, and a surgical approach is very reasonable in all class A patients independent of age. The predicted mortality in classes B, C, and particularly class BC is dismal in the elderly. Those patients may benefit from alternative, evolving therapeutic options such as ascending endovascular treatments.