Octogenarians Experience Outcomes Similar to Other Elderly Patients after Surgery for Acute Ascending Aortic Dissections

Introduction: Acute ascending aortic dissection (AAAD) is a potentially lethal disease that affects elderly patients with some frequency. The purpose of this study was to evaluate the short- and mid-term outcomes of elderly patients following surgery for AAAD. Methods: A retrospective review of the local STS database of patients ≥ 60 years of age who underwent surgery for AAAD from 2003-2013 at a US academic center was performed (n=311). Patients were compared based on age groups: 60-69 years (n=183), 70-79 years (n=95) and 80-89 years (n=33). Additionally, chart review based on ICD-9 codes was undertaken to evaluate medically managed patients during the same timeframe. The Social Security Death Index was accessed for survival data. Unadjusted outcomes were compared, and mid-term survival was calculated using Kaplan-Meier curves. Results: Octogenarians had comparable preoperative risk profiles compared to other elderly patients excepting lower body mass index (p=0.006) and underwent similar operations with no difference in concomitant coronary artery bypass grafting (p=0.19), cardiopulmonary bypass time (p=0.75), or aortic cross clamp time (p=0.71). In-hospital mortality rates by age group showed no statistical difference (p=0.69): 60-69 (18.0%), 70-79 (20.0%), and 80-89 (24.2%). There were no survivors in the group of octogenarians who underwent medical management only (0/2, p=0.07). Additionally, rates of postoperative stroke (p=0.73), renal failure (p=0.55), and myocardial infarction (p=0.49) were similar across age groups. Postoperative transfusion requirements were lower in octogenarians: 60-69 (82.0%), 70-79 (84.2%), 80-89 (72.7%) [p=0.34]. Mean 5-year survival was 62.3% for 60-69, 56.7% for 70-79, and 52.2% for 80-89. Mid-term survival was similar across all age groups (p=0.63). Conclusion: Most octogenarians can safely undergo surgery for repair of AAAD with no difference in short-term outcomes compared to other elderly patients. Short-term survival for octogenarians compares favorably to previously published results, and mid-term survival is similar to other elderly patients.