Key result
Multilevel malperfusion in elderly patients undergoing surgery for acute type A aortic dissection was associated with 70% in-hospital mortality compared to 13% without malperfusion (P<0.001).
Why the study?
The study aimed to investigate the outcomes of elderly patients with surgically treated acute type A aortic dissection complicated by malperfusion.
Does the pattern of malperfusion impact mortality in elderly patients undergoing surgery for acute type A aortic dissection?
Cohort (n=400)
Does the pattern of malperfusion impact mortality in elderly patients undergoing surgery for acute type A aortic dissection?
Absolute Event Rate: 70% vs 13%
p-value: p=<0.001
In elderly patients undergoing surgery for acute type A aortic dissection, multilevel malperfusion is associated with a 70% in-hospital mortality, suggesting surgery should be considered with extreme caution.
Extreme-risk subgroup warrants close monitoring; Level 4 data leaves open optimal management strategies.
OBJECTIVES: The aim of this study is to investigate the outcome of elderly patients with surgically treated acute type A aortic dissection (ATAAD) complicated by malperfusion. METHODS: Patients ≥70 years old who underwent surgical treatment for ATAAD between January 2000 and December 2020 were enrolled in this study and stratified by their specific Penn Classification into 4 different subgroups, where Penn Abc was defined as multilevel malperfusion. Short- and long-term outcomes were investigated. Multivariable binary logistic regression was performed to identify risk factors for 1-year mortality. RESULTS: Four hundred elderly patients underwent surgical treatment for ATAAD. A total of 204 (51%) patients had no evidence of malperfusion (Penn Aa), 106 (26.5%) had localized organic malperfusion (Penn Ab), 44 (11%) patients had systemic malperfusion (Penn Ac) and 46 (11.5%) suffered from multilevel malperfusion (Penn Abc). For the latter, in-hospital mortality was 70% (P < 0.001). Age (P < 0.006) and multilevel malperfusion (P < 0.001) were independent risk factors for 1-year mortality. Patients with multilevel malperfusion showed the worst 1-year survival (P < 0.001). In the case of Penn Aa, in-hospital mortality was 13% (P < 0.001). CONCLUSIONS: Surgery may lead to satisfactory results in the absence of malperfusion, even in octogenarians. Elderly patients with multilevel malperfusion show very poor surgical outcome. In these patients, the decision for surgery should be taken with caution. Operation, if performed, should be carried out by experienced teams only.
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Pitts et al. (2023) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=400). Multilevel malperfusion (Penn Abc) vs. No malperfusion (Penn Aa) was evaluated on In-hospital mortality (p=<0.001). Multilevel malperfusion in elderly patients undergoing surgery for acute type A aortic dissection was associated with 70% in-hospital mortality compared to 13% without malperfusion (P<0.001).
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