Proximal aortic surgery in the elderly population: Is advanced age a contraindication for surgery?

Kelly M. Wanamaker, Sameer A. Hirji, Fernando Ramirez Del Val, Maroun Yammine, Jiyae Lee, Siobhan McGurk, Prem Shekar, Tsuyoshi Kaneko

Research output: Contribution to journalArticlepeer-review

7 Scopus citations

Abstract

Objective: The study objective was to describe the clinical outcomes of elderly patients undergoing ascending aortic surgery. Methods: Patients aged 70 years or older who underwent ascending aortic surgery between January 2002 and December 2013 were examined. Of 415 included patients, 285 were elderly patients (age 70-79 years) and 130 were very elderly (age ≥80 years). Logistic regression and Cox proportional hazards models were used to evaluate operative mortality and long-term survival, respectively. Results: Surgical indications included aortic aneurysm (63.1%), calcified aorta with need for other cardiac procedure (26.4%), and type A dissection (10.5%). Compared with elderly patients, the very elderly patients had a higher burden of comorbidities and operative mortality (13% vs 7%, P <.04). The very elderly patients were also more likely to be discharged to a rehabilitation facility than home (P <.001). However, risk-adjusted operative mortality and 30-day readmissions rates were similar (P >.05). Kaplan–Meier estimates of survival at 1 and 5 years were 85.6% and 72.6% for elderly patients versus 79.2% and 57.1% for the very elderly patients. Age was a strong risk variable for late mortality in the unadjusted and adjusted analyses. Conclusions: After adjusting for these comorbidities, the cause of aortic disease, and the type of procedure, age was not an independent predictor of operative mortality, but was strongly associated with reduced late survival. Thus, advanced age alone should not be an absolute contraindication for ascending aortic surgery.

Original languageEnglish
Pages (from-to)53-63
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume157
Issue number1
DOIs
StatePublished - Jan 2019

Keywords

  • advanced age
  • aortic surgery
  • calcified aorta

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