Contemporary outcomes of open thoracoabdominal aortic aneurysm repair in octogenarians

Abstract

Objectives: We sought to evaluate our contemporary outcomes with open thoracoabdominal aortic aneurysm (TAAA) repair in octogenarians to determine whether open TAAA repair is a viable option, with acceptable risk, in this elderly cohort.

Methods: We analyzed clinical data from 1267 enrolled patients who underwent open TAAA repair between 2003 and 2013. Eighty-eight patients (7%) were octogenarians (median age, 82 years; range, 80-92 years) and 1179 were 79 years of age or less.

Results: Aneurysm rupture was more common in octogenarians (14% vs 4.7%, P = .001), whereas aortic dissections predominated in younger patients (43.9% vs 13%, P < .001). Octogenarians had higher rates of visceral-branch endarterectomy/stenting (58% vs 33.5%, P < .001), adverse postoperative outcomes (36% vs 15.3%, P < .001), operative mortality (26% vs 6.9%, P < .001), and prolonged hospital stay (P = .004). Among octogenarians, preoperative aortic dissection was most commonly associated with extent I repair (42% vs <10% for other extents, P < .001). Extent II repairs most frequently necessitated concomitant visceral-branch procedures and carried the highest risk of mortality (62%). Extent I and III repairs carried intermediate operative risk, and extent IV repairs posed the least risk (11%). Multivariate modeling analysis identified extent II TAAA (P = .001; odds ratio, 11.6), presence of concomitant dissection (P = .02; odds ratio, 5.6), and aneurysm rupture (P = .02; odds ratio, 5.7) as independent predictors of operative mortality in octogenarians.

Conclusions: Open extent II TAAA repair carries significant risk for octogenarians; extent I, III, and IV repairs incur more reasonable postoperative risk. Although TAAA repair should not be denied to octogenarians based solely on age, extensive TAAA repair should be performed with caution.