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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

Rylski, Bartosz MD*; Hoffmann, Isabell; Beyersdorf, Friedhelm MD*; Suedkamp, Michael MD*; Siepe, Matthias MD*; Nitsch, Brigitte MD*; Blettner, Maria PhD; Borger, Michael Andrew MD; Weigang, Ernst MD§Multicenter Prospective Observational Study

doi: 10.1097/SLA.0b013e3182902cca
Original Articles

Objective: To determine the association between age and clinical presentation, management and surgical outcomes in a large contemporary, prospective cohort of patients with acute aortic dissection type A (AADA).

Background: AADA is one of the most life-threatening cardiovascular diseases, and delayed surgery or overly conservative management can result in sudden death.

Methods: The perioperative and intraoperative conditions of 2137 patients prospectively reported to the multicenter German Registry for Acute Aortic Dissection Type A were analyzed.

Results: Of all patients with AADA, 640 (30%) were 70 years or older and 160 patients (7%) were younger than 40 years. The probability of aortic dissection extension to the supra-aortic vessels and abdominal aorta decreased with age (P < 0.0001 and P = 0.0017, respectively). In 1447 patients (69%), the aortic root was preserved and supracoronary replacement of the ascending aorta was done. The probability of this procedure increased with age (P < 0.0001). The incidence of new postoperative neurological disorders was not influenced by age. The lowest probability of 30-day mortality was noted in the youngest patients (11%–14% for patients aged between 20 and 40 years) and rose progressively with age, peaking at 25% in octogenarians.

Conclusions: This study reflects current results after surgical treatment of AADA in relation to patient age. Current survival rates are acceptable, even in very elderly patients. The contemporary surgical mortality rate among young patients is lower than that previously reported in the literature. The postoperative stroke incidence does not increase with age.

The aim of this study was to determine current results after surgical treatment of acute aortic dissection type A in relation to patient age. Contemporary survival rates are acceptable, even in very elderly and young patients. The postoperative stroke incidence does not increase with age.

*University Heart Center Freiburg, Freiburg, Germany

Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany

Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany

§Department for Cardiothoracic and Vascular Surgery, Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany.

Reprints: Bartosz Rylski, MD, Heart Center Freiburg University, Hugstetter Str 55, 79106 Freiburg, Germany. E-mail: bartosz.rylski@universitaets-herzzentrum.de.

Disclosure: Maria Blettner is a consultant for AstraZeneca (<$10,000/year). Ernst Weigang is sponsored by the German Society for Thoracic and Cardiovascular Surgery (GSTCVS) and is financially rewarded through this project. GERAADA is an official project of the Task force for Aortic Surgery and Interventional Vascular Surgery of the GSTCVS. GERAADA is sponsored by the GSTCVS and various companies (Medtronic, St Jude Medical, Vascutek, Edwards Lifesciences, and The Medicines Company). For the remaining authors, no conflicts of interest were declared.

© 2014 by Lippincott Williams & Wilkins.