Impact of sarcopenia on early and mid-term outcomes of surgery for acute type A aortic dissection in octogenarians

Gen Thorac Cardiovasc Surg. 2023 Nov;71(11):674-680. doi: 10.1007/s11748-023-01932-9. Epub 2023 Mar 30.


Objective: To determine the association between sarcopenia and surgical outcomes in octogenarians with acute type A aortic dissection.

Methods: We enrolled 72 octogenarians who had undergone type A aortic dissection surgery between April 2013 and March 2019. The psoas muscle index, an indexed area of the psoas muscle at the L3 level on preoperative computed tomography, was obtained as an indicator of sarcopenia. The study participants were divided into sarcopenia and non-sarcopenia groups based on the mean psoas muscle index. The postoperative outcomes were compared between the groups.

Results: The median age was 84 years (interquartile range 82-87 years), and 13 patients were male. The mean psoas muscle index was 3.53 ± 0.97 cm2/m2. Except for sex, no significant differences were observed in patients' baseline characteristics and operative data between the two groups. The 30-day mortality rates in the sarcopenia and non-sarcopenia groups were 14% and 8%, respectively (P = 0.71), and postoperative morbidity was similar in both groups. Postoperative all-cause mortality was significantly higher in the sarcopenia group (log-rank P = 0.038), especially in patients aged 85 years or older (log-rank P < 0.01). The sarcopenia group had a lower home discharge rate than the non-sarcopenia group (21% vs. 54%, P < 0.01), and home discharge was associated with longer survival (log-rank P = 0.015).

Conclusions: All-cause mortality after emergency surgery for acute type A aortic dissection was significantly higher in octogenarians with sarcopenia than in those without, especially in patients aged 85 years or older.

Keywords: Acute type A aortic dissection; Octogenarian; Psoas muscle area index; Sarcopenia.