Effectiveness and durability of open repair of abdominal aortic aneurysm in octogenarians

Abstract

BACKGROUND AND OBJECTIVES: Open repair of abdominal aortic aneurysm in patients more than 80 years of age may be associated with higher peri-operative risks. The aim of this study is to present the short and long term outcomes of open repair of aortic aneurysm in octogenarians at our institution. METHODS: Consecutive patients aged between 80 and 89 who underwent elective or emergency open repair of aortic aneurysm in a tertiary referral centre were identified from a prospectively collected departmental database. Patient demographics, pre-morbid conditions, peri-operative outcomes and long term survival were analysed. Logistic regression was used to identify predictors for surgical mortality. RESULTS: From a cohort of 512 patients who underwent open repair of abdominal aortic aneurysm from July 1990 until June 2012, 78 (15%; 54 males) were aged between 80 and 89 (1 suprarenal, 3 pararenal, 4 juxtarenal, 70 infrarenal) of whom 45 and 33 were elective and emergency procedures respectively. For elective procedures, the 30-day mortality was 4.4%, whilst emergency procedures had a 30-day mortality of 45.5% (χ2 test: p <0.001). Upon multivariate analysis, rupture of aneurysm (OR 7.2, 95% confidence interval 1.5–34.2, p = 0.012) was the only independent predictive factors of surgical mortality. The 3-year overall survival with Kaplan-Meier analysis were 62.8% and 30.3% for elective and emergency procedures respectively (Log rank test: p <0.001). On long-term follow-up, only one patient had re-intervention 23 months later, which resulted in our only aneurysm-related late mortality. CONCLUSIONS: Our study shows that open repair of aortic aneurysms in octogenarians is safe and effective, with a low 30-day elective mortality of 4.4%. Only one patient had aneurysm-related late mortality.