• Santi Trimarchi, Kim A Eagle, Christoph A Nienaber, Vincenzo Rampoldi, Frederik H W Jonker, Carlo De Vincentiis, Alessandro Frigiola, Lorenzo Menicanti, Thomas Tsai, Jim Froehlich, Arturo Evangelista, Daniel Montgomery, Eduardo Bossone, Jeanna V Cooper, Jin Li, Michael G Deeb, Gabriel Meinhardt, Thoralf M Sundt, Eric M Isselbacher, and International Registry of Acute Aortic Dissection Investigators.
• Policlinico San Donato IRCCS, San Donato Milanese, Italy. santi.trimarchi@unimi.it
• J. Thorac. Cardiovasc. Surg. 2010 Oct 1; 140 (4): 784-9.

ObjectiveThe increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection.MethodsWe analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups.ResultsThe rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group.ConclusionsAlthough the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age.Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.

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