Acute Type A Dissection in the Octogenarian
Pp. 287-297 (11)
Jennifer Chung and Dominique Shum-Tim
Acute type A aortic dissection (TAAAD) in the octogenarian is clinically
complex because the risk-benefit ratio for surgical intervention is debatable. This is
reflected by the equal incidence of medical and surgical management between the 8th and
9th decades of life. The goals of therapy must be individualized, and they often lean towards
the maintenance quality of life. Poor postoperative outcomes may be mitigated by
improving patient selection and recognizing the predictors of poor outcome. These include
shock, previous aortic valve replacement, migrating chest pain, pulse deficits, and evidence
of myocardial ischemia. In addition, small series have explored less invasive surgical
techniques successfully used for TAAAD in the elderly. These techniques can be
considered in high-risk elderly patients scheduled for surgery.
Acute type A aortic dissection, Octogenarian, Septuagenarian,
Cardiac surgery, Less invasive quick repair, Replacement, Medical management,
Mortality, Quality of life, International Registry of Aortic Dissection, Elderly,
Thoracic aorta, Acute aortic dissection, Type A dissection, Epidemiology,
Surgical technique, High-risk surgery, GRF glue, Cardiopulmonary bypass,
Complication rates, Emergency surgery.
Division of Cardiac Surgery, McGill University Health Center, 687 Avenue des Pins Ouest, Room S8-73 b, Montreal, Quebec, Canada H3A 1A1.