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This study aimed to comprehensively evaluate early clinical outcomes and perioperative risk profiles in elderly patients undergoing TAR+FET for ATAAD, thereby addressing gaps in the literature and providing evidence to guide surgical decision\u2010making in this high\u2010risk population.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A multicenter retrospective analysis was conducted involving 1634 patients who underwent TAR+FET for ATAAD between 2015 and 2023 across seven cardiovascular centers. Patients were categorized into elderly (\u2265\u200960\u2009years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009258) and non\u2010elderly (&lt;\u200960\u2009years,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u20091376) groups. Baseline characteristics, operative details, and early outcomes were compared between groups before propensity score matching (PSM). A 1:2 PSM established a balanced cohort of 699 patients (elderly,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009245; non\u2010elderly,\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u2009454), in which postoperative complications and survival were compared. To evaluate the independent prognostic impact of age, multivariable Cox proportional hazards models with incremental covariate adjustments were applied.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Before PSM, elderly patients had higher prevalences of coronary artery disease, diabetes, and hyperlipidemia, with significantly longer intensive care unit (ICU) stay, prolonged ventilation time, and lower 30\u2010day survival compared with non\u2010elderly patients. After PSM, baseline covariates were well balanced; however, elderly patients continued to demonstrate worse perioperative outcomes, including longer ICU stay (68 [35\u2013162] vs. 47 [28\u2013113] h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.001), prolonged ventilation time (49 [21\u2013111] vs. 38 [18\u201386] h,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), and higher incidences of reintubation, tracheostomy, respiratory failure, acute kidney injury (AKI), and dialysis (all\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.010). Kaplan\u2013Meier analysis revealed significantly lower 30\u2010day survival in the elderly group (86.5% vs. 93.6%,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Multivariable Cox regression identified age\u2009\u2265\u200960\u2009years as an independent predictor of mortality (hazard ratio\u2009=\u20092.286, 95% confidence interval: 1.361\u20133.840,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.002). Within the elderly subgroup, non\u2010survivors were older, had longer operative and cardiopulmonary bypass times, and experienced substantially higher rates of severe postoperative complications\u2014particularly neurological injury, dialysis\u2010requiring AKI, arrhythmia, and respiratory failure\u2014than survivors.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Even after adjustment for baseline characteristics, elderly patients undergoing TAR+FET have higher risks of perioperative complications and early mortality than non\u2010elderly patients. This unfavorable prognosis likely reflects reduced physiological reserve rather than surgical factors alone. Future strategies should emphasize individualized procedure selection and organ\u2010protective perioperative management to improve outcomes in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/agm2.70076","type":"journal-article","created":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T16:35:11Z","timestamp":1777566911000},"page":"111-128","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Early Outcomes After Total Arch Replacement With Frozen Elephant Trunk in Elderly Patients With Acute Type A Aortic Dissection"],"prefix":"10.1002","volume":"9","author":[{"given":"Jiajun","family":"Liang","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yuan","family":"Xue","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yeting","family":"Lou","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hao","family":"Han","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xiaohan","family":"Zhong","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Zhou","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery Beijing Anzhen Hospital, Capital Medical University  Beijing 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