Abstract
Objective: Although elderly patients undergoing surgery for
acute type A aortic dissection (ATAAD) is increasing, their physical
activities are not fully understood. We report the physical activities
and surgical outcomes in the elderly patients who underwent ATAAD.
Methods: From 2009 to 2019, 103 consecutive patients underwent
surgery for ATAAD at our institution. Surgical outcomes along with pre-
and postoperative physical activities in 52 elderly patients (≥70 years
old) were compared with those in 51 younger patients (<70
years old). Postoperative walking difficulty was defined as taking ≥30
days to regain the ability to walk 200 m postoperatively or as the
inability to walk at discharge.
Results: It took longer for elderly patients to regain the
ability to walk 100 or 200 m postoperatively. ROC analysis revealed the
AUC of the duration for walking 200 m postoperatively as a prognostic
indicator for late deaths was 0.878, with the highest accuracy at 30
days (sensitivity = 83.3%, specificity = 91.8%). Hospital mortality
within 30 days was 3.8%, and 1-, 3-, and 5-years survival rates were
92%, 84.7%, 84.7%, respectively, for elderly patients, with no
significant differences between groups. Cox proportional hazard analysis
showed postoperative walking difficulty was an independent risk factor
for late mortality in all cohorts (P = 0.017).
Conclusions: Elderly patients undergoing surgical ATAAD repair
showed acceptable surgical outcomes. However, they were more likely to
decrease their physical activities postoperatively. Postoperative
difficulty in walking was an independent risk factor for the late
mortality in patients with ATAAD.