Early outcomes of a triple-branched stent graft implantation in elderly patients with acute type A aortic dissection

Abstract

Abstract Purpose: Older patients with acute type A aortic dissection (ATAAD) have higher risk of mortality than that of younger patients when a total arch reconstruction (TAR) is required. Triple-branched stent graft (TBSG) implantation is a novel technique for TAR. However, early outcomes of a TBSG implantation in older patients have not been reported. This study aimed to evaluate the early outcomes of the TBSG technique in older patients with ATAAD. Methods: From February 2015 to December 2020, 640 patients who simultaneously underwent an emergent open aortic surgery and TBSG implantation for ATAAD were enrolled in this study. They were categorized into the younger (age < 70 years old, n=573) and older groups (age > 70 years, n=67). Clinical data of all patients were retrospectively reviewed. Result: The mean ages of the patients in the younger and older groups were 45.3 ± 9.6 years old and 73.5 ± 3.0 years old, respectively. Preoperative characteristics were similar between the two groups, except for weight and incidence of moderate or greater aortic regurgitation, which were lower in the older group than those in the younger group. Surgical procedure and duration (i.e., duration for cardiopulmonary bypass, aortic cross-clamp, selected cerebral perfusion, and total circulation arrest) were comparable between the two groups (p>0.05). Patients in the older group had higher incidence of dialysis for acute kidney injury and longer ICU stay compared with those in the younger group. However, the incidences of 30-day mortality (5.1% in younger group vs. 7.5% in older group, p=0.407) and other major complications (i.e., neurological adverse events) were similar between the two groups. Conclusion: TBSG implantation for ATAAD resulted in an acceptable mortality rate in patients above 70 years old; thus, it could be a feasible surgical procedure to perform in older patients with ATAAD when a TAR is required.