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Abstract

Background

We evaluated the clinical and anatomic presentations of acute type A aortic dissection according to patient age.

Methods

We retrospectively reviewed 235 consecutive patients who underwent acute type A dissection repair between January 2000 and December 2014. The influence of age on anatomical and clinical presentation, surgical management in the entire cohort and also after exclusion of patients with known connective tissue disorders was assessed using logistic regression.

Results

Males presented with type A acute aortic dissection at a younger age than females. Acute onset with signs of myocardial ischemia, connective tissue disorders, or bicuspid aortic valve characterized the younger population. Extension to the coronary sinus(es) (p = 0.0003), descending thoracic aorta (p = 0.016), and abdominal aorta (p = 0.029), and an intimal tear at the level of the aortic root (p = 0.0017) correlated inversely with patient age. Similar findings were obtained after exclusion of patients with connective tissue disorders or a bicuspid aortic valve.

Conclusions

More frequent proximal and distal progression of the dissection flap occurs in younger patients with acute type A aortic dissection. Older age is associated with a lower probability of an intimal tear at the level of the sinus of Valsalva. These findings, associated with prognostic implications, account for the choice of more radical proximal procedures for repair of aortic dissection in younger patients.

Keywords

Age factors Aorta Aneurysm dissecting Aortic root Genetic predisposition to disease Vascular surgical procedures

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References

Trimarchi

Eagle

Nienaber

et al . Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg 2010; 140:784–9.

Rylski

Hoffmann

Beyersdorf

et al . Acute aortic dissection type A. Age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients. Ann Surg 2014; 259:598–604.

Niclauss

Delay

von Segesser

LK.

Type A dissection in young patients.

Interact Cardiovasc Thorac Surg 2011; 12:194–8.

Januzzi

Isselbacher

Fattori

et al . Characterizing the young patient with aortic dissection: results from the International Registry of Aortic Dissection (IRAD). J Am Coll Cardiol 2004; 43:665–9.

Elefteriades

Pomianowski

Practical genetics of thoracic aortic aneurysm.

Prog Cardiovasc Dis 2013; 56:57–67.

Ruddy

Jones

Ikonomidis

JS.

Pathophysiology of thoracic aortic aneurysm (TAA): is it not one uniform aorta? Role of embryologic origin.

Prog Cardiovasc Dis 2013; 56:68–73.

Malvindi

Modi

Miskolczi

et al . Acute type A aortic dissection repair in elderly patients. Eur J Cardiothorac Surg 2015; 48:664–70.

Malvindi

Modi

Miskolczi

et al . Open and closed distal anastomosis for acute type A aortic dissection repair. Interact Cardiovasc Thorac Surg 2016; 22:776–83.

Puranik

Chow

Duflou

Kilborn

McGuire

MA.

Sudden death in the young.

Heart Rhythm 2005; 2:1277–82.

10.

Fan

Wang

ZY.

Aortic dissection and sudden unexpected deaths: a retrospective study of 31 forensic autopsy cases.

J Forensic Sci 2015; 60:1206–11.

11.

Dean

Woznicki

O’Gara

et al . Cocaine-related aortic dissection: lessons from the International Registry of Acute Aortic Dissection. Am J Med 2014; 127:878–85.

12.

Westover

Nakonezny

PA.

Aortic dissections in young adults who abuse amphetamines.

Am Heart J 2010; 160:315–21.

13.

Pomianowski

Elefteriades

JA.

The genetics and genomics of thoracic aortic disease.

Ann Cardiothorac Surg 2013; 2:271–9.

14.

Bee

Wilkes

Devereux

Basson

Hatcher

CJ.

TGFβRIIb mutations trigger aortic aneurysm pathogenesis by altering transforming growth factor β2 signal transduction.

Circ Cardiovasc Genet 2012; 5:621–9.

15.

Nishida

Tabata

Fukui

Takanashi

Surgical strategy and outcome for aortic root in patients undergoing repair of acute type A aortic dissection.

Ann Thorac Surg 2016; 101:1464–9.

16.

Geirsson

Bavaria

Swarr

et al . Fate of distal and proximal aorta after acute type A dissection repair using a contemporary surgical reconstruction algorithm. Ann Thorac Surg 2007; 84:1955–64.

17.

Zhang

Wang

Zheng

et al . Type A aortic dissection with arch entry tear: surgical experience in 104 patients over a 12-year period. J Thorac Cardiovasc Surg 2015; 151:1581–92.

18.

Girardauskas

Rouman

Disha

et al . Correlation between systolic transvalvular flow and proximal aortic wall changes in bicuspid aortic valve stenosis. Eur J Cardiothorac Surg 2014; 46:234–9.

19.

Mahadevia

Barker

Schnell

et al . Bicuspid aortic cusp fusion morphology alters aortic three-dimensional outflow patterns, wall shear stress, and expression of aortopathy. Circulation 2014; 129:673–82.

20.

Numata

Itatani

Kanda

et al . Blood flow analysis of the aortic arch using computational fluid dynamics. Eur J Cardiothoracic Surg 2016; 46:1578–85.

21.

Torii

Kalantzi

Theodoropoulos

Sarathchandra

Yacoub

MH.

Predicting impending rupture of the ascending aorta with bicuspid aortic valve: spatiotemporal flow and wall shear stress.

JACC Cardiovasc Imaging 2013; 6:1017–9.

22.