293EARLY AND LATE OUTCOME AFTER SURGERY FOR ACUTE TYPE A AORTIC DISSECTION IN THE ELDERLY

Objectives: We evaluated our experience in acute type A aortic dissection (ATAAD) repair in elderly patients. The role of clinical presentation and surgical strategies in determining patients' outcome was further assessed. Methods: We retrospectively reviewed the data of patients over the age of 75 who underwent emergency repair of ATAAD at our institution between 2000 and 2013. Forty-five patients (mean age = 79 ± 3 years; 26 females) were identified. Clinical presentation was complicated in 17 patients (37%) with new neurological deficit (n = 5), cardiac tamponade (n = 12), myocardial ischaemia (n = 5) and acute renal failure (n = 2). The ascending aorta was replaced in all patients and hypothermic circulatory arrest was employed in 22 patients. Aortic root replacement was required in 3 cases and hemiarch replacement was undertaken in 11 patients. Results: In-hospital mortality was 15% (n = 7). Preoperative acute neurological deficit was the only independent risk factor for mortality (P = 0.006). Increasing age was not associated with a poor outcome. Circulatory arrest and the extent of aortic replacement did not affect the operative mortality. Major complications were observed in 23 patients (51%): reoperation for bleeding/tamponade (n = 7), perioperative stroke (n = 10), need for tracheostomy (n = 5), sepsis (n = 5) and acute renal failure (n = 8). During median follow up of 57 months, there were 3 late deaths. The cumulative 1-year, 5-year and 8-year survival rates were 82%, 76% and 68%, respectively. Conclusion: Emergency surgery for ATAAD in elderly patients can be performed with acceptable early mortality and satisfactory intermediate survival. Preoperative acute neurological deficit predicts a worse outcome. Advanced age alone is not a contraindication to ATAAD repair.