Objective

Advanced age is commonly considered to be a strong relative contra-indication in acute type A aortic dissection repair. We hypothesised that appropriately selected elderly patients with relatively few co-morbidities should be offered surgical repair as their risk of medium term mortality is acceptable.

Methods

We performed a retrospective analysis of the PATS database and patient management systems in two Welsh cardiac centres. We identified all acute type A dissection repairs in the period 1999-2015. We analysed the post-operative length of stay, in-hospital and medium term mortality, comparing two age groups: under 75 years and 75 years and over. We will perform further detailed analysis regarding risk factors, risk stratification and post-operative morbidities in these patients.

Results

We identified 118 patients in total, of which 17 (14%) were 75 years or older. 66% of patients were male, median age was 62 years (20 to 82). Median post-operative length of stay was 33 days in the elderly group compared to 17 days for the younger group and risk of in-hospital mortality was 24% and 23% respectively. Of those discharged, late mortality occurred in 50% in the elderly group with a median survival of 4.6 years compared to 21% and 6.0 years respectively in the younger age group.

Conclusion

In our cohort, age over 75 is confirmed to be a significant prognostic indicator for increased length of stay and late mortality. Despite this, half of the 75 years and over group survived to discharge and experienced an acceptable medium term survival of over 4 years. This series suggests that, in appropriately selected cases, advanced age should not be considered an absolute contraindication to surgical repair of acute type A aortic dissection.