Treatment for Acute Type A Aortic Dissection in the Elderly
Patients with Stanford A acute aortic dissection who were treated within 48h of onset in our institution between January 1, 1999 to December 31, 2001 were divided into those younger than 70 years and those 70 years or older to compare the results of surgical and conservative therapies and the cause...
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| Published in | Japanese Journal of Cardiovascular Surgery Vol. 32; no. 4; pp. 209 - 214 |
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| Main Authors | , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
The Japanese Society for Cardiovascular Surgery
2003
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| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 1883-4108 |
| DOI | 10.4326/jjcvs.32.209 |
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| Abstract | Patients with Stanford A acute aortic dissection who were treated within 48h of onset in our institution between January 1, 1999 to December 31, 2001 were divided into those younger than 70 years and those 70 years or older to compare the results of surgical and conservative therapies and the cause of death. The total number of patients was 74, the age was 33 to 88 years (66.5±11.9 years), and the ratio of men to women was 39:35. Atherosclerotic aortic aneurysm was concurrently observed in 21.1% in those 70 years or older, which was significantly higher than 5.6% in those younger than 70 years. Of 36 patients younger than 70 years, 27 (75.0%) were saved, compared with 18 of 38 patients (47.4%) 70 years or older. Surgical therapy was performed on 46 patients, 62.2%. The percentage of patients who underwent surgery was 69.4% in those younger than 70 years and 55.3% in those 70 years or older with no significant differences. Operative death occurred in 9 of 21 patients (42.9%) 70 years or older, which was significantly higher than the 12.0% (3 of 25) in those younger than 70 years. For 28 patients who did not receive surgical treatment, death occurred in 6 of 11 patients (54.5%) younger than 70 years compared with 10 of 17 (58.8%) 70 years or older with no significant difference: both rates were higher than 50% and 9 patients died of rupture during operative preparation. Since elderly people have a high risk for various complications and have poor operative results, it is important to carefully determine the therapeutic strategy, select a simple operative technique and conduct the operation as soon as possible. |
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| AbstractList | Patients with Stanford A acute aortic dissection who were treated within 48h of onset in our institution between January 1, 1999 to December 31, 2001 were divided into those younger than 70 years and those 70 years or older to compare the results of surgical and conservative therapies and the cause of death. The total number of patients was 74, the age was 33 to 88 years (66.5±11.9 years), and the ratio of men to women was 39:35. Atherosclerotic aortic aneurysm was concurrently observed in 21.1% in those 70 years or older, which was significantly higher than 5.6% in those younger than 70 years. Of 36 patients younger than 70 years, 27 (75.0%) were saved, compared with 18 of 38 patients (47.4%) 70 years or older. Surgical therapy was performed on 46 patients, 62.2%. The percentage of patients who underwent surgery was 69.4% in those younger than 70 years and 55.3% in those 70 years or older with no significant differences. Operative death occurred in 9 of 21 patients (42.9%) 70 years or older, which was significantly higher than the 12.0% (3 of 25) in those younger than 70 years. For 28 patients who did not receive surgical treatment, death occurred in 6 of 11 patients (54.5%) younger than 70 years compared with 10 of 17 (58.8%) 70 years or older with no significant difference: both rates were higher than 50% and 9 patients died of rupture during operative preparation. Since elderly people have a high risk for various complications and have poor operative results, it is important to carefully determine the therapeutic strategy, select a simple operative technique and conduct the operation as soon as possible. |
| Author | Negishi, Nanao Akiyama, Kenji Obana, Masahiro Tsukamoto, Saeki Shindo, Shoji Shiono, Motomi |
| Author_xml | – sequence: 1 fullname: Tsukamoto, Saeki organization: Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center – sequence: 1 fullname: Negishi, Nanao organization: The Second Department of Surgery, Nihon University School of Medicine – sequence: 1 fullname: Akiyama, Kenji organization: The Second Department of Surgery, Nihon University School of Medicine – sequence: 1 fullname: Shindo, Shoji organization: Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center – sequence: 1 fullname: Obana, Masahiro organization: Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center – sequence: 1 fullname: Shiono, Motomi organization: The Second Department of Surgery, Nihon University School of Medicine |
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| References | 1) Bachet, J., Goudot, B., Dreyfus, G. D. et al.: Surgery for acute type A aortic dissection: the Hopital Foch experience (1977-1998). Ann. Thorac. Surg. 67: 2006-2009, 1999. 16) Kazui, T., Washiyama, N., Muhammad, B. A. H. et al.: Extended total arch replacement for acute type A aortic dissection: experience with seventy patients. J. Thorac. Cardiovasc. Surg. 119: 558-565, 2000. 12) Yasuda, K., Ayabe, H., Ide, H. et al.: Thoracic and cardiovascular surgery in Japan during 1999. Annual report by the Japanese association for thoracic surgery. Jpn. J. Thorac. Cardiovasc. Surg. 49: 528-543, 2001. 9) McKneally, M. F.: “We don't do that here”: Reflections on the Siena experience with dissecting aneurysms of the thoracic aorta in octogenarians. J. Thorac. Cardiovasc. Surg. 121: 202-203, 2001. 13) Massimo, C. G., Presenti, L. F., Favi, P. P. et al.: Simultaneous total aortic replacement from valve to bifurcation: experience with 21 cases. Ann. Thorac. Surg. 56: 1110-1116, 1993. 8) Neri, E., Toscano, T., Massetti, M. et al.: Operation for acute type A aortic dissection in octogenarians: Is it justified? J. Thorac. Cardiovasc. Surg. 121: 259-267, 2001. 11) Fehrenbacher, J., Halbrook, H. and Siderys, H.: Operation for acute type A aortic dissection in octogenarians: Is it justified? J. Thorac. Cardiovasc. Surg. 123: 393, 2002. 14) Ando, M., Nakajima, N., Adachi, S. et al.: Simultaneous graft replacement of the ascending aorta and total aortic arch for type A aortic dissection. Ann. Thorac. Surg. 57: 669-676, 1994. 4) 吉田卓義,安達秀雄,井野隆史ほか:高齢者(90歳)解離性大動脈瘤に対する上行-近位弓部大動脈置換術の1例.胸部外科47:75-77,1994. 6) Tsai, T. P., Nessim, S., Kass, R. M. et al.: Morbidity and mortality after coronary artery bypass in octogenarians. Ann. Thorac. Surg. 51: 983-986, 1991. 5) 西澤純一郎,松本雅彦,杉田隆彰ほか:高齢者(86歳)Stanford A型急性大動脈解離に対する緊急手術の1例.胸部外科54:1115-1117,2001. 15) Hirotani, T., Kameda, T., Kumamoto, T. et al.: Results of a total aortic arch replacement for an acute aortic arch dissection. J. Thorac. Cardiovasc. Surg. 120: 686-691, 2000. 2) David, T. E., Armstrong, S., Ivanov, J. et al.: Surgery for acute type A aortic dissection. Ann. Thorac. Surg. 67: 1999-2001, 1999. 10) Hagl, C. and Griepp, R. B.: Acute type A dissection in octogenarians. J. Thorac. Cardiovasc. Surg. 122: 1050-1051, 2001. 3) Westaby, S., Saito, S. and Katsumata, T.: Acute type A dissection: conservative methods provide consistently low mortality. Ann. Thorac. Surg. 73: 707-713, 2002. 7) Kawahito, K., Adachi, H., Yamaguchi, A. et al.: Early and late surgical outcomes of acute type A aortic dissection in patients aged 75 years and older. Ann. Thorac. Surg. 70: 1455-1459, 2000. 17) Ehrlich, M., Fang, W. C., Grabenwöger, M. et al.: Perioperative risk factors for mortality in patients with acute type A aortic dissection. Circulation 98: II-294-II-298, 1998. |
| References_xml | – reference: 3) Westaby, S., Saito, S. and Katsumata, T.: Acute type A dissection: conservative methods provide consistently low mortality. Ann. Thorac. Surg. 73: 707-713, 2002. – reference: 6) Tsai, T. P., Nessim, S., Kass, R. M. et al.: Morbidity and mortality after coronary artery bypass in octogenarians. Ann. Thorac. Surg. 51: 983-986, 1991. – reference: 2) David, T. E., Armstrong, S., Ivanov, J. et al.: Surgery for acute type A aortic dissection. Ann. Thorac. Surg. 67: 1999-2001, 1999. – reference: 5) 西澤純一郎,松本雅彦,杉田隆彰ほか:高齢者(86歳)Stanford A型急性大動脈解離に対する緊急手術の1例.胸部外科54:1115-1117,2001. – reference: 9) McKneally, M. F.: “We don't do that here”: Reflections on the Siena experience with dissecting aneurysms of the thoracic aorta in octogenarians. J. Thorac. Cardiovasc. Surg. 121: 202-203, 2001. – reference: 1) Bachet, J., Goudot, B., Dreyfus, G. D. et al.: Surgery for acute type A aortic dissection: the Hopital Foch experience (1977-1998). Ann. Thorac. Surg. 67: 2006-2009, 1999. – reference: 17) Ehrlich, M., Fang, W. C., Grabenwöger, M. et al.: Perioperative risk factors for mortality in patients with acute type A aortic dissection. Circulation 98: II-294-II-298, 1998. – reference: 12) Yasuda, K., Ayabe, H., Ide, H. et al.: Thoracic and cardiovascular surgery in Japan during 1999. Annual report by the Japanese association for thoracic surgery. Jpn. J. Thorac. Cardiovasc. Surg. 49: 528-543, 2001. – reference: 10) Hagl, C. and Griepp, R. B.: Acute type A dissection in octogenarians. J. Thorac. Cardiovasc. Surg. 122: 1050-1051, 2001. – reference: 13) Massimo, C. G., Presenti, L. F., Favi, P. P. et al.: Simultaneous total aortic replacement from valve to bifurcation: experience with 21 cases. Ann. Thorac. Surg. 56: 1110-1116, 1993. – reference: 15) Hirotani, T., Kameda, T., Kumamoto, T. et al.: Results of a total aortic arch replacement for an acute aortic arch dissection. J. Thorac. Cardiovasc. Surg. 120: 686-691, 2000. – reference: 14) Ando, M., Nakajima, N., Adachi, S. et al.: Simultaneous graft replacement of the ascending aorta and total aortic arch for type A aortic dissection. Ann. Thorac. Surg. 57: 669-676, 1994. – reference: 16) Kazui, T., Washiyama, N., Muhammad, B. A. H. et al.: Extended total arch replacement for acute type A aortic dissection: experience with seventy patients. J. Thorac. Cardiovasc. Surg. 119: 558-565, 2000. – reference: 7) Kawahito, K., Adachi, H., Yamaguchi, A. et al.: Early and late surgical outcomes of acute type A aortic dissection in patients aged 75 years and older. Ann. Thorac. Surg. 70: 1455-1459, 2000. – reference: 8) Neri, E., Toscano, T., Massetti, M. et al.: Operation for acute type A aortic dissection in octogenarians: Is it justified? J. Thorac. Cardiovasc. Surg. 121: 259-267, 2001. – reference: 4) 吉田卓義,安達秀雄,井野隆史ほか:高齢者(90歳)解離性大動脈瘤に対する上行-近位弓部大動脈置換術の1例.胸部外科47:75-77,1994. – reference: 11) Fehrenbacher, J., Halbrook, H. and Siderys, H.: Operation for acute type A aortic dissection in octogenarians: Is it justified? J. Thorac. Cardiovasc. Surg. 123: 393, 2002. |
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| Title | Treatment for Acute Type A Aortic Dissection in the Elderly |
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