In the endovascular era, is elective open aortic arch surgery in elderly patients still justified?

OBJECTIVE: The data supporting performing elective aortic arch surgery in patients aged 75 years or older are equivocal. We evaluated short- and long-term outcomes after elective arch surgery in patients aged ≥75 years to determine whether complex arch operations are justified in such patients.

METHODS: Over a 10-year period, 805 patients aged 50 to 89 years underwent elective proximal or total arch surgery. Composite adverse outcome was defined as operative mortality, persistent (ie, present at discharge) neurologic event, or persistent hemodialysis. Multivariable logistic regression was performed in the entire group.

RESULTS: Multivariable analysis showed that age at admission independently predicted composite adverse outcome, operative mortality, and prolonged (>48 hours) ventilator support (P < .0001 for all), but not stroke. The same results were shown in a subgroup analysis in which older age (80-89 years) was associated with composite adverse outcome, operative mortality, and prolonged ventilator support. In a Cox proportional hazards regression model adjusted for antegrade cerebral perfusion time and prior history of renal disease, patients aged 50 to 74 years had significantly better overall survival than patients aged ≥75 years (P < .001).

CONCLUSIONS: As endovascular technology evolves, having benchmark data from likely endovascular-therapy candidates is critical. This study, among the few to focus on elective aortic arch surgery in elderly patients, suggests that surgical intervention carries risk and that novel endovascular therapies are needed.