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Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study
BACKGROUND: Surgical strategies in older adult patients with acute type A aortic dissection (aTAAD) are crucial. We investigated the safety and efficiency of open limited surgery for septuagenarian and octogenarian patients with aTAAD. METHODS: Between 2011 and 2019, 1,092 patients diagnosed with aT...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
AME Publishing Company
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423737/ https://www.ncbi.nlm.nih.gov/pubmed/37583688 http://dx.doi.org/10.21037/cdt-22-533 |
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author | Chen, Zhong Chen, Cheng Chong, Hoshun Wang, Junxia Zhu, Xiyu Zhou, Qing Wang, Dongjin Xue, Yunxing |
author_facet | Chen, Zhong Chen, Cheng Chong, Hoshun Wang, Junxia Zhu, Xiyu Zhou, Qing Wang, Dongjin Xue, Yunxing |
author_sort | Chen, Zhong |
collection | PubMed |
description | BACKGROUND: Surgical strategies in older adult patients with acute type A aortic dissection (aTAAD) are crucial. We investigated the safety and efficiency of open limited surgery for septuagenarian and octogenarian patients with aTAAD. METHODS: Between 2011 and 2019, 1,092 patients diagnosed with aTAAD underwent open surgery in Nanjing Drum Tower Hospital. Patients were divided into two groups based on age: <70 years (n=956) and ≥70 years (n=136). Preoperative baseline characteristics, operative data, and postoperative outcomes were compared between the two groups. To investigate the safety and efficiency of the surgical approach for those aged ≥70 years, we separated these patients into two groups: (I) those who underwent root-sparing surgery and less-invasive arch surgery (Limited group; n=86); and (II) all others (Extensive group; n=50). RESULTS: Mortality was significantly higher in those aged ≥70 years than in those <70 years (20.6% vs. 13.2%; P=0.000), with age being a strong risk factor for postoperative mortality [odds ratio (OR) 1.619; 95% confidence interval (CI): 1.015–2.582; P=0.043]. Patients aged ≥70 years tended to receive less invasive surgery, and the rates of root replacement and arch replacement were lower. Patients in the limited surgery group had a higher rate of pericardial tamponade, and the durations of surgery, hypothermic circulation arrest, cardiopulmonary bypass, and aortic clamp were all significantly shorter than in the extensive group. Mortality and postoperative complications were also lower in the limited surgery group. CONCLUSIONS: Although older age was a risk factor for open surgery for aTAAD, limited surgical techniques could lower the mortality and morbidity regardless of the need for extensive surgery. |
format | Online Article Text |
id | pubmed-10423737 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | AME Publishing Company |
record_format | MEDLINE/PubMed |
spelling | pubmed-104237372023-08-15 Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study Chen, Zhong Chen, Cheng Chong, Hoshun Wang, Junxia Zhu, Xiyu Zhou, Qing Wang, Dongjin Xue, Yunxing Cardiovasc Diagn Ther Original Article BACKGROUND: Surgical strategies in older adult patients with acute type A aortic dissection (aTAAD) are crucial. We investigated the safety and efficiency of open limited surgery for septuagenarian and octogenarian patients with aTAAD. METHODS: Between 2011 and 2019, 1,092 patients diagnosed with aTAAD underwent open surgery in Nanjing Drum Tower Hospital. Patients were divided into two groups based on age: <70 years (n=956) and ≥70 years (n=136). Preoperative baseline characteristics, operative data, and postoperative outcomes were compared between the two groups. To investigate the safety and efficiency of the surgical approach for those aged ≥70 years, we separated these patients into two groups: (I) those who underwent root-sparing surgery and less-invasive arch surgery (Limited group; n=86); and (II) all others (Extensive group; n=50). RESULTS: Mortality was significantly higher in those aged ≥70 years than in those <70 years (20.6% vs. 13.2%; P=0.000), with age being a strong risk factor for postoperative mortality [odds ratio (OR) 1.619; 95% confidence interval (CI): 1.015–2.582; P=0.043]. Patients aged ≥70 years tended to receive less invasive surgery, and the rates of root replacement and arch replacement were lower. Patients in the limited surgery group had a higher rate of pericardial tamponade, and the durations of surgery, hypothermic circulation arrest, cardiopulmonary bypass, and aortic clamp were all significantly shorter than in the extensive group. Mortality and postoperative complications were also lower in the limited surgery group. CONCLUSIONS: Although older age was a risk factor for open surgery for aTAAD, limited surgical techniques could lower the mortality and morbidity regardless of the need for extensive surgery. AME Publishing Company 2023-03-22 2023-04-28 /pmc/articles/PMC10423737/ /pubmed/37583688 http://dx.doi.org/10.21037/cdt-22-533 Text en 2023 Cardiovascular Diagnosis and Therapy. All rights reserved. https://creativecommons.org/licenses/by-nc-nd/4.0/Open Access Statement: This is an Open Access article distributed in accordance with the Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International License (CC BY-NC-ND 4.0), which permits the non-commercial replication and distribution of the article with the strict proviso that no changes or edits are made and the original work is properly cited (including links to both the formal publication through the relevant DOI and the license). See: https://creativecommons.org/licenses/by-nc-nd/4.0 (https://creativecommons.org/licenses/by-nc-nd/4.0/) . |
spellingShingle | Original Article Chen, Zhong Chen, Cheng Chong, Hoshun Wang, Junxia Zhu, Xiyu Zhou, Qing Wang, Dongjin Xue, Yunxing Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title | Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title_full | Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title_fullStr | Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title_full_unstemmed | Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title_short | Safety of open limited surgery for septuagenarian and octogenarian acute type A aortic dissection patients: a retrospective cohort study |
title_sort | safety of open limited surgery for septuagenarian and octogenarian acute type a aortic dissection patients: a retrospective cohort study |
topic | Original Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10423737/ https://www.ncbi.nlm.nih.gov/pubmed/37583688 http://dx.doi.org/10.21037/cdt-22-533 |
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