Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off?

Authors:
Mohammad A Zafar, MBBS
Mohammad A Zafar, MBBS
Aortic Institute at Yale-New Haven Hospital
Research Director
New Haven, CT | United States

Eur J Cardiothorac Surg 2017 May;51(5):965-970

Aortic Institute at Yale-New Haven Hospital, Yale University School of Medicine, New Haven, CT, USA.

Objectives: The objective of this study is to retrospectively analyse surgical outcomes in patients aged 75-79, and 80 and above.

Methods: Between 2000 and 2015, 108 patients aged 75-79 (G 75 , mean age 76.9 ± 1.5years) and 72 patients aged 80 and above (G 80 , mean age 82.2 ± 2.1years) underwent elective aneurysm repair. Operative outcome and survival was compared with 727 contemporary younger counterparts aged <75 years (G Ctrl , mean age 56.6 ± 11.7years).

Results: Postoperatively, patients with advanced age showed a higher incidence of prolonged ventilation (G 80 21.4%, G 75 8.4%, G Ctrl 2.9%; P < 0.001), low cardiac output syndrome (G 80 11.4%, G 75 1.9%, G Ctrl 2.2%; P = 0.001), multi organ failure (G 80 2.9%, G 75 0%, G Ctrl 0.1%; P = 0.022), haemofiltration (G 80 8.6%, G 75 0.9%, G Ctrl 0.6%; P < 0.001), and infection (G 80 10.0%, G 75 6.5%, G Ctrl 3.5%; P = 0.017). Operative mortality was significantly increased in the elderly (G 80 11.1%, G 75 3.7%, G Ctrl 1.4%; P < 0.001). Mid-term survival differed significantly between the surgical groups. Multivariate regression analysis precluded age as an independent predictor of operative mortality.

Conclusions: Elderly patients showed a higher operative risk compared to their younger counterparts. However, age per se is no suitable indicator of surgical risk and well-selected patients with large threatening aneurysms may benefit from intervention.

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Source
http://dx.doi.org/10.1093/ejcts/ezw437DOI Listing
May 2017
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