The impact of age on patients undergoing aortic arch surgery: Evidence from a multicenter national registry

Objective: Elderly patients are typically offered aortic surgery at similar diameter thresholds as younger patients, despite limited data quantifying their operative risk. We aim to report the incremental risk experienced by elderly patients undergoing aortic arch surgery. Methods: In total, 2520 patients underwent aortic arch surgery between 2002 and 2018 in 10 centers. Patients were divided into 3 groups:<65 years (n = 1325), 65 to 74 years (n = 737), and >= 75 years (n = 458). Outcomes of interest were in-hospital mortality, stroke, and the modified Society of Thoracic Surgeons composite for mortality or major morbidity (STS-COMP). Multivariable modeling was performed to determine the association of age with these outcomes. Results: As age increased, there was an increasing rate of comorbidities, including diabetes (P<.001), renal failure (P<.001), and previous stroke (P =.01). Rates of acute aortic syndrome (P =.50) and total arch repair were similar (P =.59) between groups. Older patients had greater mortality (<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). After multivariable risk-adjustment, a step-wise increase in complications was observed in the older age groups relative to the youngest 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). Conclusions: Older patients experienced elevated rates of mortality and morbidity following aortic arch surgery. These results support a more measured approach when evaluating elderly patients. Further research is needed on age-dependent natural history of thoracic aneurysms and size thresholds for intervention.