eComment. Rationale for operating on the elderly with acute type A dissection.

Contemporary results after surgical repair of type A aortic dissection in patients aged 80 years and older: a systematic review and meta-analysis. Multidisciplinary standardized care for acute aortic dissection: design and initial outcomes in a regional care model. et al. Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. et al. Antegrade thoracic stent grafting during repair of acute DeBakey I dissection prevents development of thoracoabdominal aortic aneurysms. Investigators. Cerebral protection during surgery for acute aortic dissec-tion type A: results of the German registry for acute aortic dissection type a (GERAADA). Operative delay for peripheral malperfusion syndrome in acute type A aortic dissection: a long-term analysis. Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutive cases.lysis for hospital mortality in patients with acute type A aortic dissection. outcomes of rapid, minimally invasive resection of acute type A aortic dissection in octogenarians. Outcomes after surgical treatment for type A acute aortic dissection in octogenarians: a multicenter study. I read with great interest the paper by Kilic et al. [1]. This single centre experience documents 117 patients with type A acute aortic dissection, treated during an 8-year span with excellent results at 30 days and at one year after the surgical intervention. The authors concluded that elderly patients should not be contraindicated to surgical repair. A large body of modern evidence has shown that an age >70 years is an independent preoperative predictor of mortality in patient undergoing surgical intervention for acute type A aortic dissection. The International Registry of Acute Aortic Dissection (IRAD) [2], which includes 18 large referral centres around the world, found in a predictive score to distinguish risk of death that age >70 years is a significant predictor of in-hospital surgical mortality. Other independent pre-operative predictors of mortality are shock at presentation, any pulse deficit and myocardial ischaemia. The German Registry for Acute Aortic Dissection Type A (GERAADA) [3], which gathered data from 44 German centres, also identified age as a predictor of increased mortality. In particular, octogenarians patients showed a significantly higher 30-day mortality rate (odds ratio, 3.23; confidence interval, 1.81-5.72). In the last decade, the number of elderly patients suffering from acute type A aortic dissection and undergoing surgery has been steadily increasing. However, without surgical intervention, approximately 75% of those patients die within 2 weeks …