Influence of age and the burden of ischemic injury on the outcome of Type A aortic dissection repair.

Ann Thorac Surg. 2019 Jun 05;:

Authors: Kreibich M, Rylski B, Czerny M, Siepe M, Beyersdorf F, Chen Z, Branchetti E, Vallabhajosyula P, Szeto WY, Bavaria JE, Desai ND

Abstract
BACKGROUND: To evaluate operative details and postoperative outcomes in elderly patients according to the burden of ischemic injury.
METHODS: Between 2002 and 2017, 1187 patients in two centers were operated on for aortic dissection Type A (ADA). Patients were grouped according to the Penn Classification: Class A n=628, Class B n=196, Class C n=224, Class BC n=139. The perioperative conditions and outcomes were analyzed.
RESULTS: The likelihood of presenting in a Penn Class changed significantly with age (p=0.02). Also, the probability of ADA extension into the supra-aortic vessels (p<0.001) or the distal aorta (p<0.001) 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 morality increased significantly in all Penn Classes with age (p<0.001). Yet, predicted mortality remained below 15% for any age in Class A patients, but increased up to 25% in Class B and C and beyond 50% in Class BC. Class A or B were not predictive of in-hospital mortality in septuagenarians or octogenarians CONCLUSIONS: Age by itself is not a rational criterion to select patients for surgery 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.

PMID: 31175869 [PubMed – as supplied by publisher]

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