Treatment for Acute Type A Aortic Dissection in the Elderly

(Department of Cardiovascular Surgery, National Hospital Tokyo Disaster Medical Center, Tachikawa, Japan and The Second Department of Surgery, Nihon University School of Medicine*, Tokyo, Japan)
Saeki Tsukamoto Shoji Shindo Masahiro Obana
Kenji Akiyama* Motomi Shiono* Nanao Negishi*
Patients with Stanford A acute aortic dissection who were treated within 48h of onset in our institution between January 1,1999 to December 31,2001 were divided into those younger than 70 years and those 70 years or older to compare the results of surgical and conservative therapies and the cause of death. The total number of patients was 74, the age was 33 to 88 years (66.5±11.9 years), and the ratio of men to women was 39: 35. Atherosclerotic aortic aneurysm was concurrently observed in 21.1% in those 70 years or older, which was significantly higher than 5.6% in those younger than 70 years. Of 36 patients younger than 70 years, 27 (75.0%) were saved, compared with 18 of 38 patients (47.4%) 70 years or older. Surgical therapy was performed on 46 patients, 62.2%. The percentage of patients who underwent surgery was 69.4% in those younger than 70 years and 55.3% in those 70 years or older with no significant differences. Operative death occurred in 9 of 21 patients (42.9%) 70 years or older, which was significantly higher than the 12.0% (3 of 25) in those younger than 70 years. For 28 patients who did not receive surgical treatment, death occurred in 6 of 11 patients (54.5%) younger than 70 years compared with 10 of 17 (58.8%) 70 years or older with no significant difference: both rates were higher than 50% and 9 patients died of rupture during operative preparation. Since elderly people have a high risk for various complications and have poor operative results, it is important to carefully determine the therapeutic strategy, select a simple operative technique and conduct the operation as soon as possible.
　Jpn. J. Cardiovasc. Surg. 32: 209 -214（2003)