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Type B Aortic Dissection in Patients Aged 30 Years or Younger: A Retrospective Multicentre Study.
Murat Yildiz1,2, Maximilian Luehr3, Wei-Guo Ma4
1Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern 3010, Switzerland.
Summary
Type B aortic dissection (TBAD) in young patients is often linked to heritable thoracic aortic disease (HTAD). While surgical repair shows excellent outcomes, HTAD increases the risk of repeat aortic interventions.
Area of Science:
- Cardiovascular Surgery
- Genetics
- Vascular Medicine
Background:
- Type B aortic dissection (TBAD) is uncommon in individuals under 30, with limited data available.
- Heritable thoracic aortic disease (HTAD) is a significant factor in young patients with TBAD.
- Understanding TBAD in this demographic is crucial for effective management.
Purpose of the Study:
- To characterize the etiology and outcomes of invasively treated young patients with TBAD.
- To investigate the impact of HTAD on the presentation and prognosis of TBAD in patients aged 30 years or younger.
- To compare outcomes based on TBAD complexity and treatment strategies.
Main Methods:
- A retrospective analysis of 139 patients aged ≤30 years with TBAD across 19 international centers.
- Exclusion of chronic TBAD cases, with classification into uncomplicated (n=86) and complicated (n=53) TBAD.
- Kaplan-Meier and Andersen-Gill analyses to assess survival and recurrent aortic interventions, stratified by HTAD status and surgical approach.
Main Results:
- Heritable thoracic aortic disease (HTAD) was identified in 57% of patients.
- Most patients presented with uncomplicated TBAD (62%); high-risk uncomplicated cases were rare.
- Excellent mid-term survival was observed across all subgroups, with low early mortality.
- HTAD significantly predicted recurrent aortic interventions (HR=3.3, P=.004).
Conclusions:
- Type B aortic dissection in young patients frequently occurs in the setting of HTAD.
- Both open and endovascular repair strategies yield excellent early outcomes and mid-term survival.
- HTAD is a critical factor associated with an increased likelihood of recurrent aortic interventions in this population.
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