Peri-operative and Quality of life outcomes in Octogenarians following Acute Type A Aortic Dissection repair.

P0253 

Abstract Submission 

Harry Smith (1), Fadi Al-Zubaidi (1), Shakil Farid (1), Ravi Joseph De Silva (1), Jason Ali (1)

(1) Royal Papworth Hospital, Cambridge, Cambridgeshire

Harry Smith    -  Contact Me
Royal Papworth Hospital

Fadi Al-Zubaidi    -  Contact Me
Royal Papworth Hospital

Shakil Farid    -  Contact Me
Royal Papworth Hospital

Ravi Joseph De Silva    -  Contact Me
Royal Papworth Hospital

Jason Ali    -  Contact Me
Royal Papworth Hospital

Harry Smith    -  Contact Me
N/A

Objectives

Assess peri-operative outcomes and post-operative quality of life of octogenarians undergoing acute type A aortic dissection (TAAD) repair at our centre.

Method

We performed a retrospective analysis of prospectively collected operative and early outcome data between 2011 and 2022. We identified 543 patients who underwent TAAD, 56 patients were identified as being octogenarian. We report the baseline patient characteristics, intra-operative variables, and early postoperative outcomes for all octogenarians. We then assessed medium-term survival by generating Kaplan-Meier curves.

We contacted patients who were discharged and administered an SF-36 questionnaire to assess their quality of life at a median follow up of 58 months. Aggregate scores were calculated for each domain of the SF-36 questionnaire ranging from 0 to 100 compiled as percentages where the higher the score the more favourable the health.

Results

Amongst octogenarians undergoing TAAD repair, median age was 82 years (interquartile range 1 year), with a median Euroscore II of 13.9 (Interquartile range 13.4). 23 patients underwent isolated ascending aorta graft repair. 16 underwent aortic arch surgery (including 3 frozen elephant trunk procedures), 6 underwent ascending aorta replacement and valve replacement, 11 underwent aortic root surgery and 6 patients underwent concomitant CABG and 19 underwent concomitant valve replacement or repair. 16 patients underwent deep hypothermic circulatory arrest (DHCA), of this group 12 underwent DHCA and had cerebral antegrade perfusion, 4 underwent DHCA alone.

Median bypass time was 177 minutes (IQR 72.5 minutes) and cross clamp time was 90 minutes (IQR 36.8 minutes). 10 patients we re-explored for rebleeding or tamponade. Median ITU stay was 4 days (2-10), and median length of hospital stay was 14 days (9-18).

51 patients were discharged, 5 died prior to discharge representing 8.9% in house mortality. 30-day mortality was 19.6%, 6-month mortality was 26.7%- and 1-year mortality was 32.1%.

Of the 24 patients who were alive during 24th September 2023, 20 responded to the SF-36 questionnaire administered to assess various domains of quality of life. For the physical functioning domain (10 items) the average score was 48.1% ± 9.8%, for social functioning (2 domains), 62.1% ± 3.19 pain (2 domains) 86.7% ± 3.3%, general health (5 domains) 60.1% ±17.2 % and for the emotional well-being domain (5 domains) 75.5% ± 19.2%.

Conclusion

At our centre between 2011 and 2022, octogenarians operated on for Type A Aortic Dissection who survived past an initial period of increased mortality risk have SF36 scores comparable to octogenarians of a non-operated cohort. This suggests that ATAAD repair can successfully return octogenarians to a good quality of life.

Natural History/Follow-Up