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Sakakibara Heart Institute

Outcomes of emergency open surgery for type A acute aortic dissection in patients of 75 years or older. Minoru Tabata , MD, MPH, Akihito Matsushita, MD, Toshihiro Fukui, MD, Shigefumi Matsuyama, MD, Tomoki Shimokawa , MD, Shuichiro Takanashi , MD

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Sakakibara Heart Institute

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  1. Outcomes of emergency open surgery for type A acute aortic dissection in patients of 75 years or older Minoru Tabata, MD, MPH, Akihito Matsushita, MD, Toshihiro Fukui, MD, Shigefumi Matsuyama, MD, Tomoki Shimokawa, MD, ShuichiroTakanashi, MD Department of Cardiovascular Surgery, Sakakibara Heart Institute Department of Cardiovascular Surgery, Teikyo University Aortic Symposium 2012 Sakakibara Heart Institute

  2. Background • Emergency open surgery is the gold standard for type A acute aortic dissection. • Surgical outcomes in elderly patients with type A acute aortic dissection have been poorly defined. • Thorough operative risk assessment is difficult in emergency situations. • We evaluated early and late outcomes of emergency open surgery for type A acute aortic dissection in the elderly and explored predictors of poor surgical outcomes. Sakakibara Heart Institute

  3. Patients • Between 01/04 and 06/11, 422 patients underwent emergency open surgery for type A acute aortic dissection at out institution. • Of those, we reviewed 124 patients of 75 years or older. • We also reviewed 26 patients (≥ 75 years old) who were diagnosed with type A acute aortic dissection during the same period but did not underwent surgery. • The diagnosis was made with contrast CT in all patients. Sakakibara Heart Institute

  4. Methods • Operative death was defined as death within 30 days after surgery or before discharge. • Median follow-up period of operative patients was 560 days (range: 3 to 2,534 days). • Late survival rates were calculated by Kaplan-Meier method. • We explored predictors of adverse event (operative death, stroke or length of stay > 30 days) using a stepwise multivariate logistic regression model. Sakakibara Heart Institute

  5. Decision-making process for our elderly patients with type A acute aortic dissection Sakakibara Heart Institute

  6. Operative patients’ characteristics Sakakibara Heart Institute

  7. Operative data Sakakibara Heart Institute

  8. Operative outcomes Sakakibara Heart Institute

  9. Late survival of surgical patients 1-year survival: 89.3% 3-year survival: 84.7% 5-year survival: 79.1% # at risk 124 63 41 23 10 1 Sakakibara Heart Institute

  10. Predictors of adverse event after surgery Predictors included in the initial model Age, woman, cardiac tamponade, preoperative CPR, preoperative neurologic deficit, previous sternotomy, preoperative hematocrit and serum creatinine. Predictors in the final stepwise model Sakakibara Heart Institute

  11. Outcomes of elderly patients without surgery Sakakibara Heart Institute

  12. Conclusions • Emergency open surgery for type A acute aortic dissection in patients of 75 years or older resulted in low mortality but high incidence of stroke. • Preoperative cardiopulmonary resuscitation and previous sternotomy were predictors of postoperative adverse event. • Our findings may be useful for decision-making in elderly patients with type A acute aortic dissection. Sakakibara Heart Institute

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