Analisi dei contemporanei risultati della chirurgia riparativa delle Sindromi Aortiche Acute nei pazienti anziani: uno studio multicentrico Europeo Contemporary outcomes of surgery for Acute Aortic Syndrome in the elderly: a multicenter European study

Background. Acute type A Aortic Syndrome (ATAAS) is a critical emergency condition that necessitates immediate surgical repair due to its high morbidity and mortality rates. With the aging population, there is an increasing incidence of elderly patients with ATAAS. However, surgery remains controversial for this population due to the heightened risk of mortality and morbidity, particularly in the emergency setting. This study investigates the current outcomes of surgical repair of Acute Stanford type A aortic dissection (TAAD) in patients aged ≥ 80 years. Methods. The study analysed all patients enrolled in the European Registry of Type A Aortic Dissection (ERTAAD). This includes patients who received surgery for acute ATAAS at 18 hospitals across eight European countries (n = 3902). The octogenarians group consisted of 326 patients aged 80 years or above, while the non-octogenarians group consisted of 3576 patients under 80 years of age. The outcomes of the elderly group were compared with those of the non-elderly group in unmatched cohorts and in propensity score matched cohorts. Predictors of in-hospital mortality were identified through multilevel mixed-effect logistic regression analysis. Results. The overall in-hospital mortality rate was 31.6% for the octogenarians group and 16.4% for the control group (p<0.0001). No significant difference was observed between the causes of death in the hospital. The postoperative complication rate was not different between the groups. Multilevel mixed-effect logistic regression identified age ≥85 years, preoperative estimated glomerular filtration rate, preoperative invasive ventilation, preoperative mesenteric malperfusion and aortic root replacement as independent predictors of in-hospital mortality. Conclusions. This multicenter cohort study showed that early and late postoperative mortality in older patients is higher than in the younger, despite similar rates of postoperative complications. It is important to note that age alone should not be a factor for excluding surgical repair, but a thorough assessment of the operative risk profile and frailty degree of elderly patients is essential.