[Outcome of type I acute aortic dissection operated after 70 years of age. A retrospective study of operated dissection of the aorta in the over 70 years old].

The aim of this study was to assess the perioperative mortality and long-term outcome of Type I dissection of the aorta operated in patients over 70 years age. Of the 87 dissections of the aorta operated between 1988 and 1995, 19 concerned patients aged 71 to 79 (average 74.1 +/- 2.4 years). The procedure was replacement of the ascending aorta with gluing of the false lumen in call ases. Two patients also underwent aortic valve replacement and three also had replacement or repair of the aortic arch. Eleven patients (56%) had circulatory arrests lasting an average of 33 minutes (10-86 minutes). The mortality rate at 30 days was 31.5% (6/19): 3 deaths were due to bleeding, 1 to mesenteric infarction, 1 to cardiac arrhythmia and 1 to a cerebrovascular accident. The morbidity was 53%, mainly due to neurological complications, chest infection and renal failure. After an average period of 36.8 months (range: 3 to 75 months) with no patient lost to follow-up, the late mortality was 23% (3/13), giving actuarial survival rates at 1.5 and 6 years of 63%, 47.5% and 32%, respectively (including the operative mortality). Or the survivors, 9 were in NYHA Classes I-II and 1 in class III. One patient developed a hemiparesis. The authors conclude that, despite high mortality and morbidity at 30 days, long-term survival and its quality are arguments in favour of surgical management, even in elderly patients.