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Midterm outcomes of emergency surgery for acute type A aortic dissection in octogenarians.
Bojko, Markian M; Suhail, Maham; Bavaria, Joseph E; Bueker, Alex; Hu, Robert W; Harmon, Joey; Habertheuer, Andreas; Milewski, Rita K; Szeto, Wilson Y; Vallabhajosyula, Prashanth.
Afiliación
  • Bojko MM; College of Medicine, Drexel University, Philadelphia, Pa.
  • Suhail M; Department of Internal Medicine, Richmond University Medical Center, Staten Island, NY.
  • Bavaria JE; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Bueker A; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Hu RW; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Harmon J; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Habertheuer A; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Milewski RK; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Szeto WY; Division of Cardiovascular Surgery, University of Pennsylvania, Philadelphia, Pa.
  • Vallabhajosyula P; Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Conn. Electronic address: Prashanth.Vallabhajosyula@yale.edu.
J Thorac Cardiovasc Surg ; 163(1): 2-12.e7, 2022 Jan.
Article en En | MEDLINE | ID: mdl-32624307
OBJECTIVE: The incidence of elderly patients with acute type A aortic dissection is increasing. A recent analysis of the International Registry of Acute Aortic Dissection failed to show a mortality benefit with surgery compared with medical management in octogenarians. Therefore, we compared our institutional outcomes of emergency surgery for acute type A aortic dissection in octogenarians versus septuagenarians to understand the outcomes of surgical intervention in elderly patients. METHODS: From 2002 to 2017, 70 octogenarians (aged ≥80 years) and 165 septuagenarians (70-79 years) underwent surgery for acute type A aortic dissection (N = 235, total). Quality of life was assessed by the RAND Short Form-36 quality of life survey. Midterm clinical and functional data were obtained retrospectively. RESULTS: At baseline, septuagenarians had a higher prevalence of diabetes (20.6% vs 5.7%, P = .01). The prevalence of cardiopulmonary resuscitation was 4.8% versus 10.0% (P = .24) in septuagenarians and octogenarians. The prevalence of cardiogenic shock was 18.2% versus 27.1% (P = .17). Thirty-day/in-hospital mortality was 21.2% versus 28.6% (P = .29). Multivariable logistic regression identified cardiogenic shock as an independent risk factor for in-hospital mortality (odds ratio, 10.07; 95% confidence interval, 2.30-44.03) in octogenarians. Survival at 5 years was 49.7% (42.1%-58.6%) versus 34.2% (23.9%-48.8%) in septuagenarians and octogenarians, respectively. Responses to the quality of life survey were no different between septuagenarians and octogenarians across all 8 quality of life categories. CONCLUSIONS: Clinical outcomes after surgery for acute type A aortic dissection are similar in octogenarians and septuagenarians. For discharged survivors, quality of life remains favorable and does not differ between the 2 groups.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Calidad de Vida / Choque Cardiogénico / Procedimientos Quirúrgicos Vasculares / Aneurisma de la Aorta Torácica / Tratamiento de Urgencia / Disección Aórtica Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Calidad de Vida / Choque Cardiogénico / Procedimientos Quirúrgicos Vasculares / Aneurisma de la Aorta Torácica / Tratamiento de Urgencia / Disección Aórtica Tipo de estudio: Etiology_studies / Prognostic_studies / Risk_factors_studies Aspecto: Patient_preference Límite: Aged / Aged80 / Female / Humans / Male País/Región como asunto: America do norte Idioma: En Revista: J Thorac Cardiovasc Surg Año: 2022 Tipo del documento: Article Pais de publicación: Estados Unidos