@article{Fiore2024, 
author = {Antonio Fiore and Javier Rodriguez Lega and Joscha Buech and Giovanni Mariscalco and Andrea Perrotti and Konrad Wisniewski and Angel G. Pinto and Till Demal and Jan Rocek and Petr Kacer and Giuseppe Gatti and Igor Vendramin and Mauro Rinaldi and Eduard Quintana and Dario Di Perna and Francesco Nappi and Mark Field and Amer Harky and Matteo Pettinari and Angelo M. Dell’Aquila and Francesco Onorati and Mikko Jormalainen and Tatu Juvonen and Timo Mäkikallio and Caroline Radner and Sven Peterss and Vito D’Andrea and Fausto Biancari},
title = {Survival after surgery for acute type A aortic dissection in octogenarians},
year = {2024},
journal = {Journal of Geriatric Cardiology},
volume = {21},
number = {11},
pages = {1015-1025},
url = {https://www.sciopen.com/article/10.26599/1671-5411.2024.11.009},
doi = {10.26599/1671-5411.2024.11.009},
abstract = {Objective To evaluate the benefits of surgical repair acute type A aortic dissection (ATAAD) on survival of octogenarians. Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection (ERTAAD) were the subjects of the present analysis. Results326 (8.4%) patients were aged ≥ 80 years. Among 280 propensity score matched pairs, in-hospital mortality was 30.0% in patients aged ≥ 80 years and 20.0% in younger patients (P = 0.006), while 10-year mortality were 93.2% and 48.0%, respectively (P < 0.001). The hazard of mortality was higher among octogenarians up to two years after surgery, but it became comparable to that of younger patients up to 5 years. Among patients who survived 3 months after surgery, 10-year relative survival was 0.77 in patients aged < 80 years, and 0.46 in patients aged ≥ 80 years. Relative survival of octogenarians decreased markedly 5 years after surgery. Age ≥ 85 years, glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians (AUC = 0.792; E:O ratio = 0.991; CITL = 0.016; slope = 1.096). An additive score was developed. A risk score ≤ 1 was observed in 68.4% of patients, and their in-hospital mortality was 20.9%. Conclusions Provided a thoughtful patient selection, surgery may provide a survival benefit in patients aged ≥ 80 years with ATAAD that, when compared to younger patients and the general population, may last up to 5 years after the procedure. These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.}
}