Surgical management for acute type A aortic dissection in patients over 70 years-old.

BACKGROUND

This study aimed to retrospectively investigate our experience of surgical treatment for acute type A aortic dissection in patients older than 70 years.

METHODS

From September 2005 to January 2012, eleven patients who were older than 70 years underwent surgical treatment for type A aortic dissection at our center and were included in this study. Total arch replacement was performed in three patients, seven patients underwent subtotal arch replacement and one with single-branched stent graft implantation. One patient underwent a valve-sparing (David) procedure while another underwent a concomitant aortic valve replacement (Wheat procedure). One patient required coronary artery bypass grafting. All operations were performed under deep hypothermic circulatory arrest and selective antegrade cerebral perfusion.

RESULTS

There was one in-hospital death (9.1%) and no operative mortality within 30 days. Cardiopulmonary bypass time, myocardial ischemic time and antegrade cerebral perfusion time accounted for 151.4 ± 33.5 minutes, 68.5 ± 41.4 minutes and 30.3 ± 12.9 minutes, respectively. Overall in-hospital duration, intensive care unit (ICU) time and mean ventilation time were 40.9 ± 40.3 days, 16.5 ± 22.5 days and 90.5 ± 139.4 hours, respectively. New postoperative permanent neurological dysfunction and temporary neurological dysfunction were observed in one patient (9.1%) and in three patients (27.3%), respectively. Mean follow-up was 49.0 ± 19.9 months and nine patients are still alive, one patient died of cancer after 24 months postoperation.

CONCLUSIONS

Surgical management for acute type A dissection in patients older than 70 years is a safe alternative with acceptable risk of death and the early and late results are satisfactory.