Elective surgery for ascending aortic aneurysm in the elderly: Should there be an age cut-off?

OBJECTIVES: The objective of this study is to retrospectively analyse surgical outcomes in patients aged 7579, and 80 and above. METHODS: Between 2000 and 2015, 108 patients aged 7579 (G75, mean age 76.9 1.5years) and 72 patients aged 80 and above (G80, mean age 82.2 2.1years) underwent elective aneurysm repair. Operative outcome and survival was compared with 727 contemporary younger counterparts aged < 75 years (GCtrl, mean age 56.6 11.7years). RESULTS: Postoperatively, patients with advanced age showed a higher incidence of prolonged ventilation (G80 21.4%, G75 8.4%, GCtrl 2.9%; P < 0.001), low cardiac output syndrome (G80 11.4%, G75 1.9%, GCtrl 2.2%; P = 0.001), multi organ failure (G80 2.9%, G75 0%, GCtrl 0.1%; P = 0.022), haemofiltration (G80 8.6%, G75 0.9%, GCtrl 0.6%; P < 0.001), and infection (G80 10.0%, G75 6.5%, GCtrl 3.5%; P = 0.017). Operative mortality was significantly increased in the elderly (G80 11.1%, G75 3.7%, GCtrl 1.4%; P < 0.001). Mid-term survival differed significantly between the surgical groups. Multivariate regression analysis precluded age as an independent predictor of operative mortality. CONCLUSIONS: Elderly patients showed a higher operative risk compared to their younger counterparts. However, age per se is no suitable indicator of surgical risk and well-selected patients with large threatening aneurysms may benefit from intervention.