Repair of thoracoabdominal aortic aneurysms in octogenarians

Abstract

Background: Reports on octogenarians undergoing coronary revascularization, valve replacement, and abdominal aneurysmorrhaphy demonstrate little increase in operative risk during elective procedures. However, the mortality in this group of patients increases rapidly when urgent or emergent procedures are performed. We analyzed the outcome of patients in their ninth decade of life undergoing repair of thoracoabdominal aortic aneurysms.

Methods: A retrospective review of 39 consecutive octogenarians undergoing repair of thoracoabdominal aortic aneurysms.

Results: Thirty-nine of the past 900 patients with thoracoabdominal aortic aneurysms (5.2%) repaired by us were between the ages of 80 and 89 years. The median age was 84 years with a male-to-female ratio of 1:3. Two of 39 patients (5%) had acute type III dissections, and the remainder had chronic aneurysms. Twelve patients had Crawford extent I aneurysms, whereas 7, 10, and 10 patients were extent II, III, and IV, respectively. The overall in-hospital mortality was 10.3% (4 of 39 patients). Major postoperative complications included paraperesis/paraplegia, 5% (n = 2); renal failure, 18% (n = 7) including hemodialysis in 3 patients; stroke, 5% (n = 2); myocardial infarction or arrhythmia, 18% (n = 7); and respiratory insufficiency, 36% (n = 14) including 4 patients requiring tracheostomy. A univariate analysis of perioperative risk factors was performed using the Fisher's exact test. The need for hemodialysis (p = 0.035), a tracheostomy (p = 0.0001), or a perioperative myocardial infarction (p < 0.001) significantly increased the risk of death.

Conclusions: Repair of thoracoabdominal aortic aneurysms in octogenarians can be performed with acceptable morbidity and mortality. However, survival decreases dramatically with even single system organ failure. An extended period of recovery is usually required in these elderly, high-risk patients.