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.