Key result
In patients undergoing acute type A aortic dissection repair, age ≥75 was not significantly associated with operative mortality (16.1% vs 10.2%; p=0.078) but increased 1-year mortality risk.
Why the study?
Elderly patients are less likely to undergo surgery for acute type A aortic dissection, leaving the risks of surgical repair in patients aged 75 and older poorly understood.
Does age 75 and older increase operative and long-term mortality in patients undergoing acute type A aortic dissection repair compared to patients under 75?
Cohort (n=601)
No
Does age 75 and older increase operative and long-term mortality in patients undergoing acute type A aortic dissection repair compared to patients under 75?
Age alone should not deter operative intervention for acute type A aortic dissection, as operative mortality and late survival (>1 year) are similar between patients ≥75 and <75 years, despite higher mortality in the first postoperative year.
Objective Elderly patients are less likely to undergo surgery for an acute type A aortic dissection (ATAAD). This study aims to understand the risks of surgical treatment in patients 75 and older. Methods This was a retrospective study using an institutional database of patients who underwent ATAAD repair from 2007 to 2021. Outcomes were compared between patients <75 and patients ≥ 75. Logistic regression was performed for operative mortality, and Cox regression was performed for long-term mortality. Results A total of 601 patients underwent surgery for ATAAD, 112 (18.6%) of whom were ≥75. Patients ≥75 were significantly more likely to undergo hemiarch replacement (vs total arch replacement) and concomitant CABG. Operative mortality was 16.1% in patients ≥75 versus 10.2% in those <75 ( p = 0.078). On multivariable logistic regression, age ≥75 was not significantly associated with operative mortality ( p = 0.068). Effect of age on long-term mortality was time-dependent: on Cox regression, being 75 or older and within one-year post-discharge was significantly associated with an increased hazard of death (time-dependent HR 4.56; 95% CI, 2.31–9.06; p < 0.001), while age was not associated with an increased hazard of death after the first postoperative year ( p = 0.779). Conclusion Despite reduced survival during the first postoperative year among patients 75 years and older, operative mortality and late survival were similar across each group. By implication, age alone should not be a deterrent to operative intervention in ATAAD patients, even though further investigation is needed to determine opportunities for improving survival during the first postoperative year after ATAAD repair.
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Jones et al. (2025) conducted a cohort in Acute type A aortic dissection (ATAAD) (n=601). Age ≥75 years vs. Age <75 years was evaluated on Operative mortality (p=0.078). In patients undergoing acute type A aortic dissection repair, age ≥75 was not significantly associated with operative mortality (16.1% vs 10.2%; p=0.078) but increased 1-year mortality risk.
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