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J Thorac Cardiovasc Surg 2008;135:984-985
© 2008 The American Association for Thoracic Surgery

Editorial

"We didn't expect dementia and diapers": Reflections on the Nihon experience with type A aortic dissection in octogenarians

Department of Surgery and Joint Centre for Bioethics, University of Toronto, Toronto, Ontario, Canada

Received for publication October 17, 2007; accepted for publication October 25, 2007.

^_* Address for reprints: Martin F. McKneally, MD, PhD, Department of Surgery and Joint Centre for Bioethics, University of Toronto, 77 Forest Grove Dr, Toronto, ON M2K 1Z4, Canada. (Email: martin.mckneally@utoronto.ca).

The first 20% of the full text of this article appears below.

See related article on page 1042.

 

In this issue, Mitsumasa Hata and his colleagues¹ at the Nihon University in Tokyo report their experience with emergency surgical intervention in octogenarians with acute type A aortic dissection. They move us from a lively earlier discussion in the Journal, based on the Siena experience, of the medical factors salient to answering the question of whether we "should" be doing this^2-6 to a deeper level of discourse about the quality of life of patients and their families after surgical treatment. "Because we surgeons looked after the patients in our outpatient clinic," Hata's group realized and reflected thoughtfully on some of the troubling unfavorable intermediate and long-term outcomes. Of 30 patients treated surgically, 4 died, 5 became bedridden because of cerebral damage or severe depression after surgical intervention and subsequently died during institutional care, and 13 died of various unrelated illnesses or injuries in late follow-up.

The 50 octogenarian patients "were divided into 2 groups, 31 underwent emergency surgery, 28 were treated conservatively because the patient or family refused surgery." Every surgeon will recognize the undescribed nuances of this sorting process, the shades of meaning presented to families that inclines them toward or away from consenting to surgical treatment. This is part of the burden of surgeons, who give their own informed consent to accept and endure the responsibility and consequences of these decisions.

Questions that begin with "should" signal the need for explicit discussion of ethics: the . . . [Full Text of this Article]

Related Article

Should emergency surgical intervention be performed for an octogenarian with type A acute aortic dissection?

Mitsumasa Hata, Akira Sezai, Tetsuya Niino, Masataka Yoda, Satoshi Unosawa, Nobuyuki Furukawa, Shunji Osaka, Tomohiko Murakami, and Kazutomo Minami
J. Thorac. Cardiovasc. Surg. 2008 135: 1042-1046. [Abstract] [Full Text] [PDF]