Outcomes of Acute Type A Aortic Dissection in Octogenarians: Tokyo Acute Aortic Super-Network Registry

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.

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.

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.

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.