Methods
Computed tomography angiography and echocardiography were used to
provide a definitive ATAAD diagnosis. After the diagnosis was confirmed,
the patient was promptly transferred to the operating room. The ATAAD
was confirmed by intraoperative findings. Variables were collected from
patient’s medical records and preoperative examination. Preoperative
characteristics including sex, body mass index (BMI), comorbidities,
type of aortic dissection, malperfusion, shock (systolic blood pressure
(sBP) level <80 mmHg), and pre- and postoperative physical
activities were compared between the groups. Surgical variables
including operation time, cardiopulmonary bypass time, surgical
procedure, postoperative complications, intensive care unit (ICU) and
hospital stay, hospital death within 30 days, use of walking aids at
discharge, late mortality, and aortic reintervention were also compared
between the groups. In the patients who regained ambulatory autonomy at
discharge, rehabilitation outcomes including duration to ability to walk
100 and 200 m postoperatively, blood pressure levels before and after
rehabilitation, antihypertensive drug administration during
rehabilitation, intervention of speech and swallowing therapy after
extubation, and duration of ICU and hospital stay were also compared
between the groups. Long-term outcomes were obtained through patient
follow up. We examined patients at our outpatient clinic. The median
follow-up period for the entire cohort was 49 months (19.5–90.5), and
the follow-up rate was 100%.
We applied the same surgical strategies for the elderly patients and the
young patients. Our surgical procedure comprised median sternotomy with
standard cardiopulmonary bypass. The subclavian artery, left ventricular
apex, or femoral artery was used for arterial cannulation. Antegrade or
retrograde of cold blood cardioplegic solution was infused for
myocardial protection. Surgery was performed under hypothermic
circulatory arrest (bladder temperature, 20°C–26°C), and open distal
anastomosis was performed under circulatory arrest with or without
antegrade selective cerebral perfusion. In general, a tear-oriented
surgical strategy was conducted.9 Ascending
replacement was performed in patients for whom the entry site was
located in the ascending aorta or was not found in the ascending aorta
or aortic arch (DeBakey IIIb retrograde dissection). Total or partial
arch replacement was performed in patients whose entry site extended to
or was located in the aortic arch. Although aortic valves were preserved
whenever possible, we performed aortic root replacement when the intimal
tear extended to the sinus of Valsalva or when we observed root dilation
associated with annuloaortic ectasia.