Advertisement

Replacing the ascending aorta in the elderly: do or do not

  • Ahmed Al-Adhami
  • Amer Harky
  • Mohamad BashirEmail author
  • Shyamsunder Kolvekar
Review Article

Abstract

Advanced age is a proven independent factor for perioperative morbidity and mortality in all forms of aortic surgery and forms an important variable in most available risk scores. Improvements in selection and perioperative management of high-risk elderly cohorts have reduced the incidence of adverse outcomes. Concerns remain however in the surgical and anesthesiology community that exposing elderly frail patients to ascending aortic surgery is associated with significant risk. As with many clinical scenarios, individualization of care for each patient is of paramount importance. With advances in our understanding of perioperative and intraoperative care, age should no longer be considered in isolation as a contraindication to ascending aortic surgery.

Keywords

Aorta Elderly Aneurysm 

Notes

Compliance with ethical standards

No ethical approval required for this study.

Informed consent

No informed consent was needed for this review.

Conflict of interest

The authors declare that they have no conflicts of interest.

References

  1. 1.
    Estrera AL, Miller CC, Huynh TT, Porat EE, Safi HJ. Replacement of the ascending and transverse aortic arch: determinants of long-term survival. Ann Thorac Surg. 2002;74:1058–64.CrossRefGoogle Scholar
  2. 2.
    Safi HJ, Miller CC, Lee TY, Estrera AL. Repair of ascending and transverse aortic arch. J Thorac Cardiovasc Surg. 2011;142:630–3.CrossRefGoogle Scholar
  3. 3.
    Orimo H, Ito H, Suzuki T, Araki A, Hosoi T, Sawabe M. Reviewing the definition of “elderly”. Geriatr Gerontol Int. 2006;6:149–58.CrossRefGoogle Scholar
  4. 4.
    Ortman JM, Velkoff VA, Hogan H. An Aging Nation: The Older Population in the United States; Current Population Reports. Washington, DC: US Census Bureau, Population Projections Branch; 2014.Google Scholar
  5. 5.
    Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38:2739–91.CrossRefGoogle Scholar
  6. 6.
    Peterss S, Mansour AM, Zafar MA, et al. Elective surgery for ascending aortic aneurysm in the elderly: should there be an age cut-off? Eur J Cardiothorac Surg. 2017;51:965–70.CrossRefGoogle Scholar
  7. 7.
    Sorabella RA, Wu YS, Bader A, et al. Aortic root replacement in Octogenarians offers acceptable perioperative and late Outcomes. Ann Thorac Surg. 2016;101:967–72.CrossRefGoogle Scholar
  8. 8.
    Davies RR, Goldstein LJ, Coady MA, et al. Yearly rupture or dissection rates for thoracic aortic aneurysms: simple prediction based on size. Ann Thorac Surg. 2002;73:17–27.CrossRefGoogle Scholar
  9. 9.
    Shah PJ, Estrera AL, Miller CC, et al. Analysis of ascending and transverse aortic arch repair in octogenarians. Ann Thorac Surg. 2008;86:774–9.CrossRefGoogle Scholar
  10. 10.
    Erbel R, Aboyans V, Boileau C, et al. 2014 ESC Guidelines on the diagnosis and treatment of aortic diseases: Document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The Task Force for the Diagnosis and Treatment of Aortic Diseases of the European Society of Cardiology (ESC). Eur Heart J. 2014;35:2873–926.CrossRefGoogle Scholar
  11. 11.
    Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg. 2005;129:112–22.CrossRefGoogle Scholar
  12. 12.
    Neri E, Toscano T, Massetti M, et al. Operation for acute type A aortic dissection in octogenarians: is it justified? J Thorac Cardiovasc Surg. 2001;121:259–67.CrossRefGoogle Scholar
  13. 13.
    Urbanski PP, Hijazi H, Dinstak W, Diegeler A. Valve-sparing aortic root repair in acute type A dissection: how many sinuses have to be repaired for curative surgery? Eur J Cardiothorac Surg. 2013;44:439–43.CrossRefGoogle Scholar
  14. 14.
    Bonser RS, Ranasinghe AM, Loubani M, et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol. 2011;58:2455–74.CrossRefGoogle Scholar
  15. 15.
    Subramanian S, Leontyev S, Borger MA, Trommer C, Misfeld M, Mohr FW. Valve-sparing root reconstruction does not compromise survival in acute type A aortic dissection. Ann Thorac Surg. 2012;94:1230–4.CrossRefGoogle Scholar
  16. 16.
    Trimarchi S, Eagle KA, Nienaber CA, et al. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg. 2010;140:784–9.CrossRefGoogle Scholar
  17. 17.
    Rylski B, Hoffmann I, Beyersdorf F, et al. Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg. 2014;259:598–604.CrossRefGoogle Scholar
  18. 18.
    Suenaga E, Sato M, Fumoto H. Ascending aortic replacement for acute type A aortic dissection in octogenarians. Gen Thorac Cardiovasc Surg. 2016;64:138–43.CrossRefGoogle Scholar
  19. 19.
    Bruno VD, Chivasso P, Guida G, Vohra HA. Surgical repair of Stanford type A aortic dissection in elderly patients: a contemporary systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5:257–64.CrossRefGoogle Scholar
  20. 20.
    Biancari F, Vasques F, Benenati V, Juvonen T. Contemporary results after surgical repair of type A aortic dissection in patients aged 80 years and older: a systematic review and meta-analysis. Eur J Cardiothorac Surg. 2011;40:1058–63.Google Scholar
  21. 21.
    Tang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D. Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg. 2013;145:S186–90.CrossRefGoogle Scholar
  22. 22.
    El-Sayed Ahmad A, Papadopoulos N, Detho F, et al. Surgical repair for acute type A aortic dissection in octogenarians. Ann Thorac Surg. 2015;99:547–51.CrossRefGoogle Scholar
  23. 23.
    Piccardo A, Regesta T, Pansini S, et al. Should octogenarians be denied access to surgery for acute type A aortic dissection? J Cardiovasc Surg (Torino). 2009;50:205–12.Google Scholar
  24. 24.
    Ehrlich MP, Ergin MA, McCullough JN, et al. Results of immediate surgical treatment of all acute type A dissections. Circulation. 2000;102:III248–52.CrossRefGoogle Scholar
  25. 25.
    Castaño M, Gualis J, Martínez-Comendador JM, Martín E, Maiorano P, Castillo L. Emergent aortic surgery in octogenarians: is the advanced age a contraindication? J Thorac Dis. 2017;9:S498–507.CrossRefGoogle Scholar
  26. 26.
    Chiappini B, Schepens M, Tan E, et al. Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J. 2005;26:180–6.CrossRefGoogle Scholar
  27. 27.
    Piccardo A, Le Guyader A, Regesta T, et al. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg. 2013;96:851–6.CrossRefGoogle Scholar
  28. 28.
    Baikoussis NG, Antonopoulos CN, Papakonstantinou NA, Argiriou M, Geroulakos G. Endovascular stent grafting for ascending aorta diseases. J Vasc Surg. 2017;66:1587–601.CrossRefGoogle Scholar
  29. 29.
    Jackson RS, Chang DC, Freischlag JA. Comparison of long-term survival after open vs endovascular repair of intact abdominal aortic aneurysm among Medicare beneficiaries. JAMA. 2012;307:1621–8.CrossRefGoogle Scholar
  30. 30.
    Cheng D, Martin J, Shennib H, et al. Endovascular aortic repair versus open surgical repair for descending thoracic aortic disease a systematic review and meta-analysis of comparative studies. J Am Coll Cardiol. 2010;55:986–1001.CrossRefGoogle Scholar
  31. 31.
    Moon MC, Greenberg RK, Morales JP, et al. Computed tomography-based anatomic characterization of proximal aortic dissection with consideration for endovascular candidacy. J Vasc Surg. 2011;53:942–9.CrossRefGoogle Scholar
  32. 32.
    Shah A, Khoynezhad A. Thoracic endovascular repair for acute type A aortic dissection: operative technique. Ann Cardiothorac Surg. 2016;5:389–96.CrossRefGoogle Scholar
  33. 33.
    Fattori R, Lovato L, Buttazzi K, Di Bartolomeo R, Gavelli G. Extension of dissection in stent-graft treatment of type B aortic dissection: lessons learned from endovascular experience. J Endovasc Ther. 2005;12:306–11.CrossRefGoogle Scholar
  34. 34.
    Neuhauser B, Czermak BV, Fish J, et al. Type A dissection following endovascular thoracic aortic stent-graft repair. J Endovasc Ther. 2005;12:74–81.CrossRefGoogle Scholar
  35. 35.
    Eggebrecht H, Thompson M, Rousseau H, et al. Retrograde ascending aortic dissection during or after thoracic aortic stent graft placement: insight from the European registry on endovascular aortic repair complications. Circulation. 2009;120:S276–81.CrossRefGoogle Scholar
  36. 36.
    Tsilimparis N, Debus ES, Oderich GS, et al. International experience with endovascular therapy of the ascending aorta with a dedicated endograft. J Vasc Surg. 2016;63:1476–82.CrossRefGoogle Scholar
  37. 37.
    Nienaber CA, Sakalihasan N, Clough RE, et al. Thoracic endovascular aortic repair (TEVAR) in proximal (type A) aortic dissection: Ready for a broader application? J Thorac Cardiovasc Surg. 2017;153:S3–S11.CrossRefGoogle Scholar
  38. 38.
    Muetterties CE, Menon R, Wheatley GH. A systematic review of primary endovascular repair of the ascending aorta. J Vasc Surg. 2018;67:332–42.CrossRefGoogle Scholar
  39. 39.
    Roselli EE, Idrees J, Greenberg RK, Johnston DR, Lytle BW. Endovascular stent grafting for ascending aorta repair in high-risk patients. J Thorac Cardiovasc Surg. 2015;149:144–51.CrossRefGoogle Scholar
  40. 40.
    Roselli EE, Idrees JJ, Johnston DR, Eagleton MJ, Desai MY, Svensson LG. Zone zero thoracic endovascular aortic repair: A proposed modification to the classification of landing zones. J Thorac Cardiovasc Surg. 2018;155:1381–9.CrossRefGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2018

Authors and Affiliations

  • Ahmed Al-Adhami
    • 1
  • Amer Harky
    • 2
  • Mohamad Bashir
    • 3
    Email author
  • Shyamsunder Kolvekar
    • 4
  1. 1.Department of Cardiothoracic SurgeryGolden Jubilee National HospitalGlasgowUK
  2. 2.Department of Vascular SurgeryCountess of ChesterChesterUK
  3. 3.Department of Aortovascular SurgeryManchester Royal InfirmaryManchesterUK
  4. 4.Department of Cardiac SurgeryBarts Heart CentreLondonUK

Personalised recommendations