Aging Med (Milton). 2026 Apr 30;9:111-128. doi: 10.1002/agm2.70076. eCollection 2026 Apr.
ABSTRACT
OBJECTIVE: The clinical efficacy and early outcomes of total arch replacement with frozen elephant trunk (TAR+FET) in elderly patients presenting with acute type A aortic dissection (ATAAD) remain incompletely characterized. This study aimed to comprehensively evaluate early clinical outcomes and perioperative risk profiles in elderly patients undergoing TAR+FET for ATAAD, thereby addressing gaps in the literature and providing evidence to guide surgical decision-making in this high-risk population.
METHODS: A multicenter retrospective analysis was conducted involving 1634 patients who underwent TAR+FET for ATAAD between 2015 and 2023 across seven cardiovascular centers. Patients were categorized into elderly (≥ 60 years, n = 258) and non-elderly (< 60 years, n = 1376) groups. Baseline characteristics, operative details, and early outcomes were compared between groups before propensity score matching (PSM). A 1:2 PSM established a balanced cohort of 699 patients (elderly, n = 245; non-elderly, n = 454), in which postoperative complications and survival were compared. To evaluate the independent prognostic impact of age, multivariable Cox proportional hazards models with incremental covariate adjustments were applied.
RESULTS: Before PSM, elderly patients had higher prevalences of coronary artery disease, diabetes, and hyperlipidemia, with significantly longer intensive care unit (ICU) stay, prolonged ventilation time, and lower 30-day survival compared with non-elderly patients. After PSM, baseline covariates were well balanced; however, elderly patients continued to demonstrate worse perioperative outcomes, including longer ICU stay (68 [35-162] vs. 47 [28-113] h, p = 0.001), prolonged ventilation time (49 [21-111] vs. 38 [18-86] h, p < 0.001), and higher incidences of reintubation, tracheostomy, respiratory failure, acute kidney injury (AKI), and dialysis (all p < 0.010). Kaplan-Meier analysis revealed significantly lower 30-day survival in the elderly group (86.5% vs. 93.6%, p = 0.002). Multivariable Cox regression identified age ≥ 60 years as an independent predictor of mortality (hazard ratio = 2.286, 95% confidence interval: 1.361-3.840, p = 0.002). Within the elderly subgroup, non-survivors were older, had longer operative and cardiopulmonary bypass times, and experienced substantially higher rates of severe postoperative complications-particularly neurological injury, dialysis-requiring AKI, arrhythmia, and respiratory failure-than survivors.
CONCLUSION: Even after adjustment for baseline characteristics, elderly patients undergoing TAR+FET have higher risks of perioperative complications and early mortality than non-elderly patients. This unfavorable prognosis likely reflects reduced physiological reserve rather than surgical factors alone. Future strategies should emphasize individualized procedure selection and organ-protective perioperative management to improve outcomes in this population.
PMID:42131788 | PMC:PMC13163943 | DOI:10.1002/agm2.70076