Despite the lack of data defining their surgical risk, elderly individuals are often offered aortic surgery at the same diameter thresholds as younger patients. A study documented the increased risk of aortic arch surgery in older patients. Between 2002 and 2018, 2520 individuals in ten centers had aortic arch surgery. Patients were separated into three groups: those aged less than 65 (n=1325), those aged 65 to 74 (n=737), and above or equal to 75 (n=458). In-hospital mortality, stroke, and the modified Society of Thoracic Surgeons composite for mortality or significant morbidity were also studied as outcomes of interest (STS-COMP). The link between age and these outcomes was investigated using multivariable modeling.
Older patients exhibited higher rates of death (<65: 6.1 % vs 65-74: 9.0 % vs 75: 14 %, P<.001), stroke (6.3 % vs 7.7 % vs 11 %, P=.01), and STS-COMP (25 % vs 32 % vs 38 %, P<.001). In terms of in-hospital mortality (65-74: odds ratio [OR] 1.57, P=.04; 75: OR, 2.94, P=.001) and STS-COMP (65-74: OR, 1.57, P<.001; 75: OR, 1.96, P<.001), there was a step-wise rise in complications in the older age groups compared to the younger ones after multivariable risk adjustment. Following aortic arch surgery, older patients had higher mortality and morbidity rates. These findings recommend a more cautious approach to assess older people. More study on the age-dependent natural history of thoracic aneurysms and intervention size criteria is needed.
Reference:www.jtcvs.org/article/S0022-5223(20)30423-2/fulltext
