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Faggion Vinholo et al. Vessel Plus 2024;8:11 https://dx.doi.org/10.20517/2574-1209.2023.150 Page 3 of 11

Figure 1. Higher risk of short-term mortality for octogenarian cohorts compared to their non-octogenarian counterparts (Reproduced
[22]
from Eranki et al. , with permission from BMC).
and preexisting immobility further compound the complexity of cases involving frail individuals.
Addressing these multifactorial issues is crucial for a comprehensive understanding of the patient’s
condition and the formulation of an appropriate treatment plan. This should be taken into consideration
during the decision-making process for surgical interventions in this vulnerable population.

Studies [27,28] highlight surgical treatment as a reasonable option, associated with lower all-cause in-hospital
[29]
mortality compared to conservative management . However, this benefit comes at the expense of
increased comorbidities, prolonged hospital stays, and a higher incidence of stroke. Literature suggests that
a more aggressive approach during ATAAD repair may lead to improved long-term survival and lower risk
[30]
for reoperation . Nonetheless, for high-risk populations such as frail patients, a “less invasive quick
replacement" becomes essential, particularly in the context of prolonged surgeries for octogenarians.
[27]

[29]
Patients undergoing surgical treatment also present with significantly lower Barthel Index (BI) scores ,
indicating a diminished ability to perform daily activities, necessitating additional support upon
discharge [29,31] . This highlights the necessity for a comprehensive discussion with patients, considering
potential impacts on independence, the need for extensive support, and the potential compromise of their
quality of life.

While the overall outcomes for elderly patients may not be as favorable as for younger patients, individual
factors such as performance status and independence with activities of daily living (ADLs) play a crucial
role in determining the appropriateness of surgery. Our previous study by Percy et al.. emphasized that
frailty, rather than age alone, is a critical predictor of mortality in patients undergoing aortic surgery .
[32]