Elective Thoracic Aortic Surgery in Elderly Patients

All articles of this category (opens in new window) Background: The decision to perform elective aortic surgery in elderly patients often presents a difficult choice due to the perceived high operative risk. Since the actual long-term aortic mortality risk for this patient group is unknown and data to guide the decision-making process are lacking, our analysis aims to provide more insight into this consideration. Methods: Patients over the age of 75 years who underwent ascending aortic or root replacement at our center were retrospectively analyzed. Partial and total arch replacements were excluded. Life expectancy at surgery was calculated using life tables of the Federal Statistical Office of Germany. Mean operative risk was calculated using the EuroSCORE II. Based on the results of the Elefteriades group (Yale, United States) regarding aortic mortality risk and growth rates, we derived a formula (growth [cm/year] = 0.02 × baseline aortic diameter + 0.02) to predict the annual growth rate. For each year, the probability of aortic-related death was determined according to corresponding diameter category (3.5–3.9 cm: 1.4%; 4.0–4.4 cm: 1.3%; 4.5–4.9 cm: 0.8%; 5.0–5.4 cm: 7.9%; 5.5–5.9 cm: 10.4%; ≥ 6.0 cm: 11.4%). Annual risk was summed across remaining life expectancy to estimate cumulative lifetime aortic risk and subsequently compared with the mean operative risk of our single-center cohort. Results: Between 2010 and 2021, 78 patients over the age of 75 underwent elective ascending aortic or aortic root replacement. The mean patient age was 77.7 ± 2.79 years, with a mean EuroSCORE II of 8.6 ± 10.98% and an average life expectancy of 10.0 ± 6.4 years. Performed procedures included supracoronary ascending replacement ( n = 41), Bentall ( n = 13), David ( n = 12), Yacoub ( n = 4), and Wheat procedures ( n = 11). The 30-day mortality was 6.4%. Our analysis revealed that for patients with a life expectancy greater than four years, the mean operative risk is lower than the estimated cumulative aortic mortality risk (7.5% vs. 9.2%). In patients with a predicted life expectancy of 13 years, the operative risk increased to 8.0%, while the cumulative aortic mortality risk was 11.2%. Conclusion: Our single-center study provides a predictive model that allows weighing the operative risk against the estimated aortic mortality risk. It may be a valuable tool for making individualized, patient-specific decisions on whether prophylactic aortic replacement is beneficial for elderly patients. However, these findings must be confirmed in larger patient collectives. Furthermore, future models should compare long-term survival after aortic surgery with the predicted cumulative lifetime aortic risk. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany