Emergency Surgery for Acute Type A Aortic Dissection in Octogenarians Without Patient Selection

Background. Octogenarians are often declined an emergency operation for acute type A aortic dissection on grounds of high mortality rate and short life expectancy. Our policy is to accept all patients at any time and never to refuse an emergency operation, even for octogenarians. Methods. From April 2004 to September 2017, 319 patients underwent surgical repair for acute type A aortic dissection at our institution. We compared the clinical results between the 55 elderly patients (>= 80 years old; older group) and the 264 nonelderly patients (<= 79 years old; younger group). The primary end point was early mortality, and the secondary end point was long-term mortality. Results. The older group had a higher proportion of women (74.5% vs 46.6%), a lower body mass index (21.4 vs 23.8 kg/m(2)), and a lower proportion of smokers (20.0% vs 46.2%). In the two groups (older vs younger), postoperative stroke occurred in 12.7% versus 11.4% and hospital mortality in 10.2% versus 10.9%, with no significant statistical difference. In multivariate analysis, older age of 80 years or older was not a significant risk factor for hospital mortality. Among the hospital survivors, the actuarial survival rate at 8 years was 52.5% in the older group and 85.0% in the younger group (p = 0.005). Conclusions. Emergency surgical repair for type A aortic dissection in octogenarians without patient selection resulted in similar rates of mortality and morbidity as younger patients. Octogenarians should not be refused this life-saving emergency operation. (C) 2019 by The Society of Thoracic Surgeons