Survival after surgery for acute type A aortic dissection in octogenarians

Objective To evaluate the benefits of surgical repair acute type A aortic dissection(ATAAD)on survival of octogenarians.Methods Patients who underwent surgery for acute ATAAD from the multicenter European Registry of Type A Aortic Dissection(ERTAAD)were the subjects of the present analysis.Results 326(8.4%)patients were aged≥80 years.Among 280 propensity score matched pairs,in-hospital mortality was 30.0%in patients aged≥80 years and 20.0%in younger patients(P=0.006),while 10-year mortality were 93.2%and 48.0%,respectively(P<0.001).The hazard of mortality was higher among octogenarians up to two years after surgery,but it became comparable to that of younger patients up to 5 years.Among patients who survived 3 months after surgery,10-year relative survival was 0.77 in patients aged<80 years,and 0.46 in patients aged≥80 years.Relative survival of octogenarians decreased markedly 5 years after surgery.Age≥85 years,glomerular filtration rate,preoperative invasive ventilation,preoperative mesenteric mal-perfusion and aortic root replacement were independent predictors of in-hospital mortality among octogenarians(AUC=0.792;E:O ratio=0.991;CITL=0.016;slope=1.096).An additive score was developed.A risk score≤1 was observed in 68.4%of patients,and their in-hospital mortality was 20.9%.Conclusions Provided a thoughtful patient selection,surgery may provide a survival benefit in patients aged≥80 years with ATAAD that,when compared to younger patients and the general population,may last up to 5 years after the procedure.These findings have significant epidemiologic and clinical relevance because of the increasing longevity of the population of the Western countries.

Exploring the role of prophylactic levosimendan in coronary surgery

Background:The role of prophylactic levosimendan in coronary surgery has not been established conclusively.Methods:Postoperative outcomes of 139 patients(mean age,68.2±9.6 years)having preoperative left ventricular ejection fraction(LVEF)≤40%and undergoing isolated coronary surgery(2013-2017)were reviewed retrospectively.In 42(30.2%)patients(L-group),an intravenous infusion of levosimendan was started 24 hours before operation.The remaining 97(69.8%)patients were the control group(C-group).A comparison between the two groups regarding outcome of surgery was performed also after propensity matching.Results:Although the risk profile in L-patients was higher than in C-patients(median European System for Cardiac Operative Risk Evaluation II,10.5%vs.6.5%,P=0.013)due to higher prevalence of New York Heart Association class III-IV,LVEF≤30%,and preoperative intra-aortic balloon pump,in-hospital mortality was equivalent(4.8%vs.3.1%,P=0.48).However,low cardiac output,multiple blood transfusion,and any major complication early after surgery were more frequent in L-patients.After one-to-one propensity matching,which resulted in 15 pairs with similar baseline characteristics the use of levosimendan was associated with a trend towards an increased blood use(P=0.077),a higher frequency of any major complication(P=0.053),and lower peak serum levels of cardiac troponin I(P=0.088).No intergroup differences concerning mid-term survival or outcomes were found even for matched patients.Conclusions:When compared with traditional inotropes alone,prophylactic use of levosimendan showed clear benefits/drawbacks neither concerning immediate nor mid-term outcomes after coronary surgery.There could be any advantage in terms of myocardial preservation.