Emergency Surgical Repair for Acute Type A Aortic Dissection in Octogenarians: A Single-Centre Experience

Emergency surgical repair for acute type A aortic dissection (ATAAD) in octogenarians remains controversial due to the perceived high operative risk. This retrospective cohort study aimed to describe in-hospital mortality, major postoperative morbidity, and mid-term survival among 23 consecutive octogenarians who underwent emergency surgical repair for ATAAD between 2014 and 2024. In-hospital mortality occurred in 5 of 23 patients (21.7%). Postoperative stroke occurred in 6 of 23 patients (26.1%), and temporary renal replacement therapy was required in 6 of 23 patients (26.1%). Estimated five-year survival was 43% (95% CI 21-65%), with a median survival of 3.88 years. Despite advanced age and significant perioperative risk, these findings demonstrate that acceptable survival outcomes can be achieved and are comparable to those reported in the International Registry of Acute Aortic Dissection (IRAD). Age alone should not preclude surgical intervention, and decisions should be individualised based on patient comorbidities, functional status, and preferences.