Utility of GERAADA score for predicting long-term survival following surgical repair of aortic dissection

Objectives: We aimed to assess the long-term survival following surgical repair because of type A aortic dissection (ATAAD) and the correlation with the preoperative GERAADA-score value. Methods: We enrolled patients who underwent emergent aortic surgery because of ATAAD from 2010 to 2022 from 9 hospitals. Follow-up information was obtained by matching the clinical patient data with a national administrative database. Discrimination and calibration of GERAADA were tested at 1-, 2-, 5-, and 10-years. The relationship between long-term outcome and score was also tested through time-to-event methods. Results: 1110 patients were analyzed: median age was 67 years [IQR 57-75], female were 30.8%. Median GERAADA score was 14.3% [10.2-22]. Mean length of follow-up was 4.19 years. The Kaplan-Meier estimates of survival at 5 and 10 years were respectively 62.5%±1.5%, and 48.5%±2.1%. Discrimination was poor but remained stable over the time (AUC at 1-year follow-up: 0.66; 95% CI 0.63-0.70. AUC at 10-year follow-up: 0.64; 95% CI 0.61-0.68). Calibration plots showed under-prediction until 50%-predicted probability and progressive over-prediction afterward. There is a steep mortality in the first couple of months after surgery while afterward the mortality rate is constantly lower. GERAADA-score was found to be a predictor of long-term mortality with a non-linear association. Conclusions: GERAADA score showed a poor performance in predicting long-term survival.