Thorac Cardiovasc Surg 2023; 71(S 01): S1-S72
DOI: 10.1055/s-0043-1761658
Sunday, 12 February
Potpourri aus der Thorax-Herz-Gefäßchirurgie

Acute Type A Aortic Dissection in Under 30 Years: Demographics, Etiology, and Postoperative Outcomes of 139 Patients

Authors

  • M. Luehr

    1   Herzzentrum Uniklinik Köln, Köln, Deutschland

  • M. Yildiz

    2   Inselspital, Bern, Switzerland

  • W. G. Ma

    3   Anzhen Aortic Surgery, Beijing, China

  • R. Heck

    4   Herzzentrum Berlin, Berlin, Deutschland

  • A. Polycarpou

    5   Mayo Clinic, Rochester, United States

  • A. Jassar

    6   Massachusetts General Hospital, Boston, United States

  • M. Kreibich

    7   Universitäts-Herzzentrum Freiburg-Bad Krozingen, Freiburg, Deutschland

  • D. S. Dohle

    8   Klinik und Poliklinik für Herz-, Thorax- und Gefäßchirurgie, Mainz, Deutschland

  • G. Weiss

    9   Klinik Floridsdorf—Wiener Gesundheitsverbund, Wien, Austria

  • C. Hagl

    10   Ludwig-Maximilians-Universität München, München, Deutschland

  • F. Rega

    11   UZ Leuven, Leuven, Belgium

  • T. Schachner

    12   Medizinische Universität Innsbruck, Innsbruck, Austria

  • A. Martens

    13   Medizinische Hochschule Hannover, Hannover, Deutschland

  • A. Della Corte

    14   University of Campania “L. Vanvitelli,” Naples, Italy

  • H. Osada

    15   Kyoto University, Kyoto, Japan

  • K. Tsagakis

    16   Westdeutsches Herzzentrum, Essen, Deutschland

  • F. Schoenhoff

    2   Inselspital, Bern, Switzerland
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Background: The prevalence and etiology of acute aortic dissection type A (AADA) in patients ≤30 years is unknown. The aims of this clinical study were to determine the prevalence and potential etiology of AADA in surgically treated patients ≤30 years and to evaluate the respective postoperative outcomes in this selective group of patients in a large multi-center study.

Method: Retrospective data collection was performed at the 16 participating international aortic institutions. All patients ≤30 years at the time of dissection onset were included. The postoperative results were analyzed with regard to connective tissue disease (CTD).

Results: The overall prevalence of AADA ≤30 years was 1.8% (139 out of 7,914 patients), including 51 (36.7%) patients who were retrospectively diagnosed with CTD. Overall in-hospital, 1- and 5-year mortality rates were was 8.6%, 2.2% and 1.4%, respectively. Actuarial survival was 80% at 10 years postoperatively. Non-CTD patients (n = 88) had a significantly higher incidence of arterial hypertension (46.6 vs. 9.8%; p < 0.001) while AADA affected the aortic root (p < 0.001) and arch (p = 0.029) significantly more often in the CTD group. A positive family history of aortic disease was present in 9.4% of the study cohort (n = 13). Independent risk factors for in-hospital and 5-year mortality were identified as entry tear in the descending aorta (OR: 17.411; 95% CI: 1.547–195.937; p = 0.021) and previous aortic surgery (OR: 44.667; 95% CI: 2.227–895.969; p = 0.013).

Conclusion: The prevalence of AADA in surgically treated patients ≤30 years is less than 2% with CTD and arterial hypertension as the two most prevalent triggers of AADA. Open surgery may be performed with good results and excellent mid- to long-term outcomes. However, previous screening in patients with syndromic features and/or a positive family history of aortic disease may have prevented AADA in more than one-third of study patients.

NB: This material has been presented at the 2022 EACTS meeting.



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Artikel online veröffentlicht:
28. Januar 2023

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