Long-term outcomes
There were eight remote deaths in the elderly group and three in the
control group during follow up (Table 4). Median follow-up time was 49
months (19.5–90.5) for all patients; 42.5 months (18.8–75.8) for
patients in the elderly group and 53 months (22.5–99) for patients in
the control group. Survival rate at 1, 3, and 5 years from initial
surgical repair, excluding hospital deaths within 30 days, was 92%
(95% CI: 0.801–0.969), 84.7% (95% CI: 0.703–0.924); and 84.7%
(95% CI: 0.703-0.924), respectively, in the elderly group compared with
97.8% (95% CI: 0.853–0.997), 97.8% (95% CI: 0.853–0.997), and
94.2% (95% CI: 0.778–0.986), respectively, in the control group. A
log-rank test comparing the two survival curves did not indicate the
significant difference between the groups (P = 0.117) (Figure 3).
Causes of remote deaths included heart failure (1), stroke (2), rupture
of the downstream aorta (1), and pneumonia (4) in the elderly patients.
There were eleven late reinterventions including repair for aortic root
(1), aortic arch (1), descending aorta (6), and abdominal aorta (3).
There were no significant differences in late reinterventions between
the groups.
To assess how postoperative physical activities after the surgery
impacted late mortality, patients with postoperative walking difficulty,
excluding hospital deaths within 30 days, were compared with patients
without postoperative walking difficulty. The patients with
postoperative walking difficulty were found to have significantly worse
late mortality compared with the patients without it (Figure 4A)
(P < 0.001).
Survival rate at 1, 3, and 5 years from initial surgical repair was
89.7% (95% CI: 0.749–0.960), 80.6% (95% CI: 0.635–0.903), and
76.4% (95% CI: 0.576–0.877), respectively, for patients with
postoperative walking difficulty vs 98.2% (95% CI: 0.878–0.997),
98.2% (95% CI: 0.878–0.997), and 98.2% (95% CI: 0.878–0.997),
respectively, for patients without postoperative walking difficulty. Cox
proportional hazard analysis showed that postoperative walking
difficulty was a significant risk factor for late mortality according to
multivariable analysis, whereas age≧70 and postoperative stroke were not
(Table 5) (HR 12.65; P = 0.017).
We also assessed the risk factors for late mortality in the patients who
regained ambulatory autonomy at discharge. Patients with
postoperative walking difficulty
were found to have significantly worse late mortality compared with the
patients without it difficulty (Figure 4B) (P < 0.001).
It was also found in Cox proportional hazard analysis that postoperative
walking difficulty was a significant risk factor for late mortality
according to multivariable analysis, whereas age≧70, re-exploration for
bleeding, and long-term intubation (>3 weeks) were not
(Table 6) (HR 15.54; P = 0.026).