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The role of age in complicated acute type B aortic dissection

Frederik H W Jonker1, Santi Trimarchi, Bart E Muhs

  • 1Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy.

The Annals of Thoracic Surgery
|September 28, 2013
PubMed

Insights

Advanced age significantly impacts outcomes for complicated acute type B aortic dissection (cABAD). Older patients (≥70 years) faced higher mortality rates across all treatment types, with age being a key predictor.

Area of Science:

  • Cardiovascular Surgery
  • Vascular Surgery
  • Aortic Diseases

Background:

  • Complicated acute type B aortic dissection (cABAD) often necessitates urgent intervention.
  • Advanced age is a known risk factor for mortality following thoracic aortic procedures.
  • The influence of age on cABAD management and outcomes requires precise investigation.

Purpose of the Study:

  • To determine the specific impact of increasing patient age on the management strategies for cABAD.
  • To analyze how advanced age affects the outcomes of patients with cABAD.
  • To compare treatment modalities and mortality rates across different age groups.

Main Methods:

  • Analysis of 583 cABAD patients from the International Registry of Acute Aortic Dissection (IRAD) (1996-2012).
  • Patients categorized by age (by decade) and treatment (medical, surgical, endovascular).
  • Outcomes were compared across age strata and management types.

Main Results:

  • Patients aged 70 years or older (36%) showed significantly increased in-hospital mortality across all treatments compared to younger patients.
  • Surgical and endovascular interventions decreased, while medical management increased with age (p < 0.001).
  • Age 70+ was an independent predictor of in-hospital mortality (OR 2.37, p=0.010).

Conclusions:

  • Advanced age profoundly influences both management choices and clinical outcomes in cABAD patients.
  • A trend towards lower mortality with endovascular treatment was observed in both younger and elderly cohorts, though not statistically significant.
  • Age is a critical factor to consider in the treatment strategy and prognosis of cABAD.
Abstract

Keywords:
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