Long-term outcome and quality of life following emergency surgery for acute aortic dissection type A: a comparison between young and elderly adults.
Objectives
Innovations in surgical techniques and perioperative management have continuously improved survival rates for acute aortic dissection type A (AADA). The aim of our study was to evaluate long-term outcome and quality of life (QoL) after surgery for AADA in elderly patients compared with younger patients.


Methods
We retrospectively evaluated 242 consecutive patients, who underwent surgery for AADA between January 2004 and April 2014. Patients were divided into two groups: those aged 70 years and older (elderly group; n  = 78, mean age, 76 ± 4 years) and those younger than 70 years (younger group; n  = 164, mean age, 56 ± 10 years). QoL was assessed with the Short Form Health Survey Questionnaire (SF-36) 1 year after surgery.


Results
The questionnaire return rate was 91.0%. There were already significant differences noted between the two groups with regard to preoperative risk factors on admission. The clinical presentation with a cardiac tamponade was higher in the elderly group (62.8% vs 47.6%; P  = 0.03). Intraoperatively, complex procedures were more common in the younger group (21.3% vs 5.2%; P  = 0.001). Accordingly, cardiopulmonary bypass and cross-clamping times were significantly longer in the younger group. The operative mortality was similar in both groups (3.8% vs 1.2%; P  = 0.33). In the elderly population, 30-day mortality was higher (21.8% vs 7.9%; P  = 0.003). One-year (72% vs 85%), 3-year (68% vs 84%) and 5-year (63% vs 79%) survival rates were satisfactory for the elderly group, but significantly lower compared with the younger group ( P  = 0.008). The physical component summary score also was similar between the groups (39.14 ± 11.12 vs 39.12 ± 12.02; P  = 0.99). However, the mental component summary score might be slightly higher in the elderly group but not statistically significant (51.61 ± 10.73 vs 48.63 ± 11.25; P  = 0.12).


Conclusions
Satisfactory long-term outcome and the general perception of well-being encourage surgery in selected elderly patients with AADA.
['Jussli-Melchers|Jill|J|', 'Panholzer|Bernd|B|', 'Friedrich|Christine|C|', 'Broch|Ole|O|', 'Renner|Jochen|J|', 'Schöttler|Jan|J|', 'Rahimi|Aziz|A|', 'Cremer|Jochen|J|', 'Schoeneich|Felix|F|', 'Haneya|Assad|A|']
D000208:Acute Disease D000293:Adolescent D000328:Adult D000367:Age Factors D000368:Aged D000369:Aged, 80 and over D000784:Aneurysm, Dissecting D001014:Aortic Aneurysm D004630:Emergencies D005260:Female D006801:Humans D053208:Kaplan-Meier Estimate D008297:Male D008875:Middle Aged D017060:Patient Satisfaction D011594:Psychometrics D011788:Quality of Life D012189:Retrospective Studies D012307:Risk Factors D016896:Treatment Outcome D014656:Vascular Surgical Procedures D055815:Young Adult
Quality of life Acute aortic dissection type A Elderly