Key result
Surgical treatment did not significantly improve 5-year survival compared to conservative treatment in elderly patients (≥80 years) with acute type A aortic dissection (48.4% vs 19.2%, p=0.103).
Why the study?
Surgical indications and surgical procedures for acute type A aortic dissection in elderly patients remain controversial.
Does surgical repair improve survival compared to conservative treatment in elderly patients (≥80 years) with acute type A aortic dissection?
Cohort (n=219)
No
Does surgical repair improve survival compared to conservative treatment in elderly patients (≥80 years) with acute type A aortic dissection?
Absolute Event Rate: 48.4% vs 19.2%
p-value: p=0.103
In elderly patients (≥80 years) with acute type A aortic dissection, surgical repair did not significantly improve 5-year survival compared to conservative management, suggesting surgery may not always be the reasonable treatment of choice.
May not improve survival with surgery versus conservative care in octogenarians with type A dissection; leaves open need for randomized trials.
BackgroundThere is controversy regarding surgical indication and surgical procedure of acute type A aortic dissection for the elderly. We examined surgical outcomes for the elderly.MethodsFrom January 2012 to December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the elderly group (≧80 years old) and the non-elderly group (≦79 years old). Additionally, we compared the surgical treatment group with the conservative treatment group.ResultsThe primary entry was found in the ascending aorta in 51.6% of the elderly group and in 32.8% of the non-elderly group (p= 0.049). In the elderly group, ascending or hemiarch replacement was performed in all cases, while in the non-elderly group, ascending or hemiarch replacement was performed in 57.3% (p<0.001). The hospital mortality was similar in both groups. The 5-year survival rate was 48.4±10.3% in the elderly group and 86.7±2.9% in the non-elderly group (p<0.001). The rates of freedom from aortic event at 5 years was 86.9±8.7% in the elderly group and 86.5±3.9% in the non-elderly group (p=0.771). The 5-year survival rate of conservative treatment group was 19.2±8.0% in the elderly. There was no significant difference from the surgical treatment group (p=0.103).ConclusionsThe surgical approach may not always be the reasonable treatment of choice for the elderly because the significant survival merit was not achieved compared with the conservative approach.
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Maze et al. (2021) conducted a cohort in Acute type A aortic dissection (n=219). Surgical treatment vs. Conservative treatment was evaluated on 5-year survival rate (p=0.103). Surgical treatment did not significantly improve 5-year survival compared to conservative treatment in elderly patients (≥80 years) with acute type A aortic dissection (48.4% vs 19.2%, p=0.103).
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