What is the clinical evidence from this study?

Study design: Cohort. Population: Thoracic aortic aneurysm (n=62). Intervention: Elective surgical repair vs. Medical management. Primary outcome: 3-year actuarial survival (p=0.022).

January 1, 2003Open Access

Comparative Study of the Natural History and Operative Outcome in Patients 75 Years and Older With Thoracic Aortic Aneurysm

YKYoshito KawachiKyushu University ANAtsuhiro NakashimaBoston Children's Hospital TKTomokazu KosugaTaoka Hospital

Key Result

Elective surgical repair of thoracic aortic aneurysms in patients aged 75 years and older significantly improved actuarial survival compared to medical management (3-year survival 83% vs 41%, p=0.022).

Study Design

Type

Cohort (n=62)

Multicenter

Structured PICO

Does operative treatment improve survival compared to medical management in patients 75 years and older with thoracic aortic aneurysm?

Population

62 patients aged 75 to 85 years with thoracic aortic aneurysms meeting operative indications, followed for a mean of 26 months to compare surgical versus medical management.

Exposure

Operative treatment (n=20), comprising emergency operations (n=11) and elective operations (n=9).

Comparator

Medical management (n=42).

Outcome

Survival rates at 1 and 3 years.hard clinical

Elective surgery for thoracic aortic aneurysm in patients aged 75 years and older yields significantly better 3-year survival than medical management, supporting elective intervention in suitable older patients.

Main Result

Absolute Event Rate: 83% vs 41%

p-value: p=0.022

Limitations

Non-randomized and retrospective study design
Small sample size limits persuasive arguments on life expectancy impact
Heterogeneous group of patients with different surgical techniques used

Abstract

Surgery for thoracic aortic aneurysm (TAA) in patients 75 years and older is a high risk, but data for their natural history are not available. In the present study the subjects were 62 patients with TAA aged on average 78 years (range, 75-85 years) enrolled between August 1994 and December 2001: 20 operatively treated patients (OPE) and 42 medically managed patients (MED). All of them had been included in the indication for TAA surgery at the time of consultation. Hospital mortality rates and survival rates (Kaplan-Meier method) were compared among emergency OPE, elective OPE, and MED. There were 136 total patient-years of follow-up. Actuarial survival in MED (ie, the natural history) was 83% at 1 year after consultation and 41% at 3 years. Hospital mortality rates in emergency and elective OPE were 27% (3/11) and 0% (0/9), respectively (p=0.22), and the corresponding 3-year survival rates were 44% and 83% (p=0.019). Actuarial survival in elective OPE was higher than that in MED (p=0.022), but that of emergency OPE was similar to that for MED (p=0.17). Patients aged 75 years and older with TAA should undergo an elective operation if the aneurysm diameter is larger than 6 cm and if the patient is asymptomatic and in good anatomicosurgical, physical, and social condition.

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