Association between age and in-hospital mortality and arch repair strategy in acute type A aortic dissection: a dose-response analysis of a retrospective cohort.
- 1Center for Heart Failure and Valvular Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Abstract
Advanced age is a recognized risk factor in acute type A aortic dissection (ATAAD), but its dose-response relationship with in-hospital mortality and the optimal extent of arch repair in elderly patients remain incompletely defined. This study aimed to determine the age-mortality dose-response relationship and to assess arch repair strategies in elderly ATAAD patients. This retrospective cohort study included consecutive ATAAD patients who underwent surgical repair at Beijing Anzhen Hospital between January 2021 and December 2024. The association between age (as a continuous variable) and in-hospital mortality was assessed using multivariable logistic regression and restricted cubic spline (RCS) analysis. In a subgroup of elderly patients (≥60 years, n=115), perioperative outcomes between no/partial arch replacement and total arch replacement were compared after 1:1 propensity score matching (PSM). The primary outcome was in-hospital mortality. Among 1,042 included patients, overall in-hospital mortality was 3.7% (39/1,042), and median age was 51 (interquartile range, 40-59) years. Age was independently associated with mortality (adjusted odds ratio 1.04 per year, 95% confidence interval: 1.01-1.07, P=0.01), and RCS analysis demonstrated a significant linear association without evidence of a threshold effect (P overall =0.02; P for non-linearity =0.31). In the elderly subgroup (n=244), 115 patients met imaging eligibility criteria for PSM, yielding 30 matched pairs. In this small matched cohort, total arch replacement was associated with longer cardiopulmonary bypass and cross-clamp times, with no statistically significant differences in mortality (6.7% vs. 3.3%) or major complications. Age shows a continuous linear association with in-hospital mortality after ATAAD repair, without evidence of a threshold effect. In elderly patients, total arch replacement and limited arch repair showed no statistically significant differences in early outcomes in this small matched cohort, suggesting that operative strategy should be individualized based on anatomical and physiological risk rather than age alone-a finding that warrants validation in larger studies.
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BibTeX
@article{fang2026association,
title = {{Association between age and in-hospital mortality and arch repair strategy in acute type A aortic dissection: a dose-response analysis of a retrospective cohort.}},
author = {Zhou Fang and Jiajun Liang and Jiazhen Mei and Qianxian Li and Yi Hu and Ming Gong},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1919},
url = {https://europepmc.org/article/MED/42996687},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Association between age and in-hospital mortality and arch repair strategy in acute type A aortic dissection: a dose-response analysis of a retrospective cohort.
AU - Zhou Fang
AU - Jiajun Liang
AU - Jiazhen Mei
AU - Qianxian Li
AU - Yi Hu
AU - Ming Gong
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1919
UR - https://europepmc.org/article/MED/42996687
AB - Advanced age is a recognized risk factor in acute type A aortic dissection (ATAAD), but its dose-response relationship with in-hospital mortality and the optimal extent of arch repair in elderly patients remain incompletely defined. This study aimed to determine the age-mortality dose-response relationship and to assess arch repair strategies in elderly ATAAD patients. This retrospective cohort study included consecutive ATAAD patients who underwent surgical repair at Beijing Anzhen Hospital between January 2021 and December 2024. The association between age (as a continuous variable) and in-hospital mortality was assessed using multivariable logistic regression and restricted cubic spline (RCS) analysis. In a subgroup of elderly patients (≥60 years, n=115), perioperative outcomes between no/partial arch replacement and total arch replacement were compared after 1:1 propensity score matching (PSM). The primary outcome was in-hospital mortality. Among 1,042 included patients, overall in-hospital mortality was 3.7% (39/1,042), and median age was 51 (interquartile range, 40-59) years. Age was independently associated with mortality (adjusted odds ratio 1.04 per year, 95% confidence interval: 1.01-1.07, P=0.01), and RCS analysis demonstrated a significant linear association without evidence of a threshold effect (P overall =0.02; P for non-linearity =0.31). In the elderly subgroup (n=244), 115 patients met imaging eligibility criteria for PSM, yielding 30 matched pairs. In this small matched cohort, total arch replacement was associated with longer cardiopulmonary bypass and cross-clamp times, with no statistically significant differences in mortality (6.7% vs. 3.3%) or major complications. Age shows a continuous linear association with in-hospital mortality after ATAAD repair, without evidence of a threshold effect. In elderly patients, total arch replacement and limited arch repair showed no statistically significant differences in early outcomes in this small matched cohort, suggesting that operative strategy should be individualized based on anatomical and physiological risk rather than age alone-a finding that warrants validation in larger studies.
SN - 2072-1439
SN - 2077-6624
ER -