10-YEAR EXPERIENCE WITH ABDOMINAL AORTIC-ANEURYSM REPAIR IN OCTOGENARIANS - EARLY RESULTS AND LATE OUTCOME

Purpose: This study was undertaken to determine the mortality and morb idity rates associated with abdominal aortic aneurysm (AAA) repair in octogenarians and to identify factors that may influence survival in t his age group. Methods: One hundred fourteen patients (mean age 83 yea rs) were admitted consecutively with 106 infrarenal and eight juxtaren al AAAs from 1984 through 1993. Ninety-four AAAs were asymptomatic, wh ereas 20 patients with symptoms had 11 intact and nine ruptured AAAs. The mean AAA diameter was 6.7 cm. Repair consisted of aortic bifurcati on grafts in 77 patients (67%), tube grafts in 35 (31%), acid extraana tomic procedures in 2 (2%). A total of 29 patients (25%) had undergone previous coronary artery bypass (24 patients) or transluminal coronar y angioplasty (five patients) either incidentally or as a preliminary procedure before resection of their AAAs. Results: The 30-day mortalit y rate for the entire series was 14%, but it declined from 23% (11/48) during the first 5 years to 8% (5/66) during the second 5 years of th e study period (p = 0.028). Fatal complications occurred in nine (9.6% ) of the 94 patients with asymptomatic AAAs and in seven (35%) ofthe 2 0 patients who had symptomatic AAAs (p = 0.008). Considering only pati ents with asymptomatic AAAs, the early mortality rate in the second 5 years (4%) improved significantly (P = 0.038) in comparison to that (1 7%) for the first 5 years of the study period. The cumulative 5-year s urvival rate of 48% for 97 available operative survivors was not quite so good as that (59%) for the normal male population of the United St ates at the age of 80 years (p < 0.0001). Nevertheless, the 5-year sur vival rate was 80% for 27 operative survivors who received previous my ocardial revascularization compared with 38% for 70 others who did not (P = 0.0077). Multiple Cox-regression analysis identified the periope rative homologous blood requirement (p = 0.03) and a history of previo us myocardial revascularization (p = 0.03) as significant independent factors influencing late survival. Conclusions: Repair of AAAs in prop erly selected octogenarians is safe and durable. When otherwise indica ted, it should not be withheld on the basis of advanced age atone. Pri or treatment of severe coronary artery disease is associated with enha nced late survival, but patient selection probably is an important con sideration in this respect.