Influence of Age on Postoperative Neurological Outcomes after Surgery of Acute Type A Aortic Dissection

• Main Authors: Mohamed Salem, Michael Salib, Christine Friedrich, Mostafa Salem, Thomas Puehler, Jan Schoettler, Felix Schoeneich, Jochen Cremer, Assad Haneya
• Format: Article
• Language: English
• Published: MDPI AG 2021-04-01
• Series: Journal of Clinical Medicine
• Subjects: acute type A aortic dissection; moderate hypothermic circulatory arrest; neurological complication in elderly after type A aortic dissection
• Online Access: https://www.mdpi.com/2077-0383/10/8/1643

Background: Acute type A aortic dissection (AAAD) is considered a fatal disease which requires an emergent surgical intervention. This study focuses onthe neurological outcome after surgical repair in cases of AAAD in comparison between elderly and young patients. Methods: a retrospective analysis of 368 consecutive patients who underwent emergency surgery of ascending aorta in moderate hypothermic circulatory arrest (MHCA) (20–24 °C) and antegrade cerebral perfusion after AAAD between 2001 and 2016. Patients were divided into two groups: those aged 75 years and older (68 (18.5%)) and those younger than 75 years (300 (81.5%)). Results: Comparing both groups, average age was 79.0 ± 3.2 vs. 59.2 ± 10.7 years (<em>p </em>< 0.001); female gender represents 58.8% of elderly patients vs. 28.7% in younger patients (<em>p </em>< 0.001). Intraoperatively, cardiopulmonary bypass time (155 min (131; 187) vs. 171 min (137; 220); <em>p </em>= 0.012), cross-clamping time (79 min (60; 105) vs. 93 min (71; 134); <em>p </em>= 0.001] and circulatory arrest time (29 min (22; 40) vs. 33 min (26; 49); <em>p </em>= 0.011) were significantly shorter in elderly than younger group. Postoperatively, there was no significant difference in delirium (11.8% vs. 20.5%; <em>p </em>= 0.0968) or stroke (11.8% vs. 16.1%; <em>p </em>= 0.369). The 30-day mortality was satisfactory for both groups but significantly higher in the elderly group (27.9% vs. 14.3%; <em>p </em>= 0.007). Conclusion: The current study concluded that surgical treatment of AAAD in elderly patients can be applied safely without increasing risk of neurological complication. However, minimizing operation time may help limit the occurrence of postoperative neurological complication.