Adult: Aorta
Total arch replacement in octogenarians and nonagenarians: A single-center 18-year experience

https://doi.org/10.1016/j.jtcvs.2019.07.092Get rights and content
Under an Elsevier user license
open archive

Abstract

Background

This study evaluates our 18-year experience of total arch replacement in the octogenarian and nonagenarian population.

Methods

Between October 1999 and March 2018, a total of 740 patients underwent total arch replacement at our institution. A total of 139 patients were aged 80 years or more (83.1 ± 2.8 years), and 601 patients were aged less than 80 years (66.9 ± 11.3 years). Early and late outcomes were compared between the groups.

Results

In the group aged 80 years or more, operative mortality occurred in 12 patients (8.6%) and significantly improved over time (P = .010). Operative mortality was significantly higher in the group aged 80 years or more (P = .033) when compared with the group aged less than 80 years (4.0%). Regarding postoperative complications, deep sternal wound infection, pneumonia, and tracheostomy occurred in significantly more patients in the group aged 80 years or more. In the group aged 80 years or more, there were 52 late deaths, with 4 aortic-related deaths. Overall survival was 55.4% ± 5.0% at 5 years and 32.2% ± 6.1% at 8 years. Multivariable Cox-hazard regression analysis demonstrated that chronic kidney disease, nonelective surgery, and concurrent procedures were significant risk factors for overall survival in the group aged 80 years or more. Cumulative incidence for reoperation was significantly lower in the group aged 80 years or more (8.7% at 5 years) compared with the group aged less than 80 years (14.2% at 5 years).

Conclusions

Total arch replacement was performed with an acceptable overall survival in octogenarians and nonagenarians, although operative mortality was higher than in younger patients. However, older patients had a lesser burden of reoperation compared with younger patients.

Key Words

aortic arch
aortic dissection
aortic operation

Abbreviations and Acronyms

AEF
aorto-esophageal fistula
CI
confidence interval
CT
computed tomography
HR
hazard ratio
MAAE
major adverse aortic event
OR
odds ratio
TAR
total arch replacement
TEVAR
thoracic endovascular aortic repair

Cited by (0)

The study protocol was reviewed and approved by the institutional review board.