[Surgical Outcomes of Stanford Type A Acute Aortic Dissection in the Patients Aged 85 Years or Above]

This retrospective analysis assessed surgical outcomes in patients aged 85 years or older who underwent emergency open thoracic aortic surgery for acute Stanford type A dissection between 2012 and 2025. Among 352 patients, 27 were classified as very elderly. Compared to younger cohorts, this group exhibited a higher prevalence of DeBakey typeⅡ dissection and thrombotic false lumen occlusion, with a lower incidence of malperfusion. The majority underwent hemiarch replacement. In-hospital mortality was low at 3.7%, and postoperative complication rates were comparable to the control group. Due to slow functional recovery, the proportion of patients discharged directly home was reduced. Despite a limited follow-up rate, three-year outcomes-including overall survival (77.4%), freedom from aortic-related mortality( 91.7%), and distal reoperation-free survival( 91.7%)-were favorable. The implementation of advanced techniques, such as staged thoracic endovascular aortic repair (TEVAR) and zone 0 TEVAR utilizing the retrograde in-situ branched stent graft (RIBS) method, effectively minimized the necessity for reintervention via thoracotomy or laparotomy. These findings underscore the clinical viability of surgical intervention in selected very elderly patients, notwithstanding inherent limitations such as referral bias and incomplete longitudinal data.