Interdiscip Cardiovasc Thorac Surg. 2026 Jul 1;41(7):ivag195. doi: 10.1093/icvts/ivag195.
ABSTRACT
OBJECTIVES: The increasing prevalence of acute Stanford type A aortic dissection (ATAAD) among octogenarians necessitates robust, large-scale data to inform surgical decision-making and risk stratification. Thus, we investigated the multicentre Tokyo Acute Aortic Super-Network database to demonstrate in-hospital mortality trends in this vulnerable patient population.
METHODS: We analysed patients with ATAAD transported to the network's participating hospitals between January 2015 and December 2022. The study population was stratified into 2 age-based groups: octogenarians (≥80 years) and non-octogenarians (<80 years). Multivariate logistic regression analysis identified independent predictors of in-hospital mortality specifically within the octogenarian group.
RESULTS: Among 5361 patients, 1467 (27.4%) were octogenarians. Overall mortality was significantly higher in the octogenarians compared to non-octogenarians (34.5% vs 15.9%; P < .001), whereas operative mortality for those undergoing surgery remained acceptable (10.5% vs 8.1%; P = .035). Multivariable analysis revealed that open false lumen (odds ratio [OR], 3.77; 95% confidence interval [CI], 2.51-5.67; P < .001), shock at arrival (OR, 2.62; 95% CI, 1.68-4.08; P < .001), out-of-hospital cardiopulmonary arrest (OR, 18.99; 95% CI, 7.72-46.72; P < .001), in-hospital cardiopulmonary arrest (OR, 17.39; 95% CI, 6.21-48.67; P < .001), and cerebral malperfusion (OR, 2.17; 95% CI, 1.16-4.06; P = .016) were related to higher mortality in octogenarian patients. Conversely, surgical intervention (OR, 0.15; 95% CI, 0.10-0.22; P < .001) and higher serum albumin levels (OR, 0.65; 95% CI, 0.42-1.00; P = .049) were associated with lower risk of mortality.
CONCLUSIONS: Although octogenarians with ATAAD had higher overall mortality, operative mortality among selected patients undergoing surgery remained acceptable, suggesting that advanced age alone should not preclude surgical intervention.
PMID:42475511 | DOI:10.1093/icvts/ivag195