Dottorato in TECNOLOGIE AVANZATE IN CHIRURGIA

Titolo della tesi: Contemporary outcomes of surgery for Acute Aortic Syndrome in the elderly: a multicenter European study

Abstract Background. Acute Type A Aortic Syndrome (ATAAS) is an urgent condition requiring immediate surgical intervention due to its high mortality and morbidity rates. As the population ages, there is a rising incidence of elderly patients diagnosed with ATAAS. However, surgery remains a contentious issue in this population due to the increased risk of mortality and morbidity, particularly in emergency situations. This study examines the results of surgery for Acute Stanford type A aortic dissection (TAAD) in patients over 80 years of age. Methods. All patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were analysed. Patients from 18 hospitals in eight European countries (n = 3902) who underwent surgery for acute ATAAS were included. The octogenarian group involved 326 patients aged 80 years or older, whereas the non-octogenarian group included 3576 patients under the age of 80. The in-hospital mortality rates of elderly and non-elderly cohorts were compared, both in unmatched and propensity score matched groups. Multilevel mixed-effect logistic regression analysis was conducted to identify predictors of said mortality. Results. In the octogenarians’ group, the in-hospital mortality rate was 31.6%, while the control group had a rate of 16.4% (p<0.0001). There were no significant differences observed in the causes of death within the hospital between the groups. The rate of post-operative complications did not differ between groups. Multilevel mixed-effects logistic regression identified age 85 years or older, pre-operative estimated glomerular filtration rate, pre-operative invasive ventilation, pre-operative mesenteric malperfusion and aortic root replacement as independent predictors of in-hospital mortality. Conclusions: Despite similar rates of postoperative complications, this multicentre cohort study shows a higher postoperative mortality in elderly patients compared to younger patients. It is crucial to note that age alone should not be a factor for excluding surgical repair. However, a comprehensive evaluation of the operative risk profile and frailty level of elderly patients is vital.