Hospital survival of aortic dissection in children

Thoracic aortic dissection (AD) is a rare occurrence in childhood and mostly associated with connective tissue disorders or congenital abnormalities. We examined the characteristics associated with AD and predictors of survival.

The Kids' Inpatient Database (1997-2009) was used to identify thoracic ADs occurring in patients <20-y-old. Clinical characteristics, as well as determinants of survival, were analyzed using standard statistical methods.

One hundred sixty-eight cases of thoracic AD were identified during the study period. Overall survival was 83%. Average length of stay was 15.9 ± 16.9 d, with charges 181,867.92 ± $211,985.00. Thoracic dissection tended to affect adolescents aged 15-19 y (67%), males (76%), and Caucasians (56%) most frequently. Most patients were privately insured (64%) and treated at urban teaching centers (86%). Commonly associated diagnoses were hypertension (18%), Marfan syndrome (15%), and aortic valve disorders (8%). When repair was performed, open repair was more frequent (88%) than endovascular repair (6%). Hemorrhage was the most common complication (19%). Multiple determinants of survival were found. Girls (mortality odds ratio: 0.21 [0.05-0.91]) fared better than boys, P = 0.023. Patients with Medicaid (2.84 [1.21-6.69]) had higher mortality versus privately insured, P = 0.014. Income, race, and hospital characteristics, and type of repair were not significant predictors, even on sub-analyses of surgical and nonsurgical groups separately.

Dissection of the thoracic aorta is a rare but significant condition affecting the pediatric population. Most repairs are performed using open technique. Payer status and gender are predictors of survival in these cases.