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Non-communicating acute type A aortic dissection in elderly patients: surgery vs. medical management.

OBJECTIVES
To evaluate the surgical and conservative outcomes of acute type A aortic dissection with a thrombosed false lumen of the ascending aorta in elderly patients.


METHODS
Patients aged over 75 years with acute type A aortic dissection admitted to our hospital from October 2011 to December 2020 were retrospectively reviewed, including those with non-communicating type without malperfusion and low pre-hospitalized physical capacity.


RESULTS
Sixty-six patients were consecutively enrolled in the medical (M, n = 30) and surgical (S, n = 36) groups. Ascending aorta was the most replaced section in the S group (78%). Groups did not differ significantly in hospital deaths, and intensive care unit and hospital stays. Two patients (7%) underwent surgery and three (10%) underwent re-dissection in the M group. No significant difference existed in physical performance decline during hospitalization between the groups. Seven patients in the M group (24%) experienced aorta-related events in the late period, as opposed to none in the S group (P = 0.003). Survival rates after 4 years were 78.3% and 71.4% in the S and M groups, respectively (P = 0.154). Cumulative incidence of overall reintervention due to aorta-event was significantly higher in the M group; however, the two groups did not differ significantly in overall aorta-related death.


CONCLUSIONS
Surgical outcomes of non-communicating acute type A aortic dissection in elderly patients were favorable. There was no significant difference of maintaining physical function at discharge, and the medical group had a significantly higher overall aorta-event rate than the surgical group.