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J Thorac Cardiovasc Surg 2002;123:393
© 2002 The American Association for Thoracic Surgery

Letters to the Editor

Operation for acute type A aortic dissection in octogenarians: Is it justified?

John Fehrenbacher, MD, Harold Halbrook, MD, Harry Siderys, MD

Methodist Hospital of Indiana
1801 N Senate Blvd
Indianapolis, IN 46202

To the Editor:

In a recent publication, Neri and associatesGo 1 suggested that operation for acute type A aortic dissection in octogenarians is not justified. In the 24 such patients who had surgery for acute type A dissection, the hospital mortality was 83%. Mean hospital stay was 37 days and the average intensive care unit stay was 19 days. None of the patients was able to function normally, and the survival at 6 months was 0%.
This is an important article because if the results are corroborated it would strongly influence whether thoracic surgeons would offer surgery to the elderly patient with acute type A dissection.
At Methodist Hospital of Indiana, in the past 10 years we have operated on 6 patients older than 80 years for acute type A dissection. Two of these patients died in the hospital for an operative mortality of 33%. The average postoperative length of stay was 7.3 days. One patient died of a stroke 3 months after discharge. The remaining 3 patients are alive and functioning well 15, 18, and 24 months after discharge.
There is no doubt that our numbers are small, but it behooves us to study our own results before turning down patients we might be able to help.
12/8/120727

doi:10.1067/mtc.2002.120727

Reference

  1. Neri E, Toscano T, Massetti M, Capannini G, Carone E, Tucci E, et al. Operation for acute type A aortic dissection in octogenarians: Is it justified? J Thorac Cardiovasc Surg. 2001;121:259-67.




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