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.