Age-related presentation of acute type A aortic dissection

Malvindi, Pietro Giorgio; Votano, Daniela; Ashoub, Ahmed; Modi, Amit; Velissaris, Theodore; Barlow, Clifford W.; Ohri, Sunil K.; Tsang, Geoffrey; Livesey, Steven; Göbölös, László

doi:10.1177/0218492318810087

Cited by 9 publications

(5 citation statements)

References 22 publications

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“…On the other hand, Group B patients had a higher frequency of Penn Class BC presentation with greater extent of dissection with organ malperfusion in association with cardiovascular collapse. This observation concurs with the observations of other groups, Malvindi et al reported that the extension to the coronary sinus, descending thoracic aorta and abdominal aorta and the presence of an intimal tear at the level of the aortic root correlated inversely with age (16). The reason for this finding might be that younger patients are more likely to have connective tissue diseases or bicuspid aortic valve, which facilitate extension of the dissection proximally and distally.…”

Section: Discussionsupporting

confidence: 92%

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

et al. 2022

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Background: Older age and female sex are thought to be risk factors for adverse outcomes after repair of acute type A aortic dissection (AAAD). The aim of this study is to analyze age-and sex-related outcomes in patients undergoing AAAD repair.Methods: Retrospective analysis of patients undergoing emergency AAAD repair. Patients were divided in Group A, patients aged ≥75 years and Group B <75. Intraoperative and postoperative data were compared between groups before and after propensity score matching. Sex differences were analyzed by age group.

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Section: Discussionsupporting

confidence: 92%

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

et al. 2022

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“…It was reported that proximal and distal progression of dissection occurred more frequently in younger T(A)AD patients. Meanwhile, age was negatively correlated with the incidence of Valsalva sinus level intimal tear, which led to the choice of more radical proximal surgical repair in younger patients [ 23 ]. Morbid obesity may be associated with the worse prognostic implications of these surgeries.…”

Section: Discussionmentioning

confidence: 99%

Morbid obesity impacts mortality among inpatients with type a aortic dissection: an analysis of the national inpatient sample

Yin

Zhi

et al. 2023

J Cardiothorac Surg

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Background Stanford type A aortic dissection (T(A)AD) is one of the most dangerous cardiovascular diseases and morbid obesity is associated with the prognosis of many cardiovascular diseases. The aim of this study is to investigate the impact of morbid obesity on in-hospital mortality, total hospital costs and discover the prevalence of morbid obesity among inpatients with T(A)AD. Methods Patients with a primary diagnosis of T(A)AD were identified from the National Inpatient Sample database (NIS) from 2008 to 2017. These patients were categorized into non-obesity, obesity and morbid obesity. Multivariable regression models were utilized to assess the association between obesity/morbid obesity and in-hospital mortality, total cost and other clinical factors. The temporal trend in prevalence of obesity/morbid obesity in T(A)ADs and the trend of in-hospital mortality among different weight categories were also explored. Results From the NIS database 8489 T(A)AD inpatients were identified, of which 7230 (85.2%) patients were non-obese, 822 (9.7%) were obese and 437 (5.1%) were morbid obese. Morbid obesity was associated with increased risk of in-hospital mortality (odds ratio [OR] 1.39; 95% confidence interval [CI] 1.03–1.86), 8% higher total cost compared with the non-obese patients. From 2008 to 2017, the rate of obesity and morbid obesity in patients with T(A)AD have significantly increased from 7.36 to 11.33% (P < 0.001) and from 1.95 to 7.37% (P < 0.001). Factors associated with morbid obesity in T(A)ADs included age, female, elective admission, hospital region, dyslipidemia, smoking, rheumatoid arthritis/collagen vascular diseases, chronic pulmonary disease, diabetes and hypertension. Conclusions Morbid obesity are connected with worse clinical outcomes and more health resource utilization in T(A)AD patients. Appropriate medical resource orientation and weight management education for T(A)AD patients may be necessary.

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“…[2][3][4] Although many studies have explored the risk factors of acute AD, 4 it has been shown that the risk factors from different age groups differ. [4][5][6][7] All these results suggest that younger patients may have different characteristics than the older patients and new modalities of risk factor assessment should be introduced.…”

Section: Introductionmentioning

confidence: 99%

Comparison of imaging characteristics for mortality risk analysis between young and older acute aortic dissection patients

Zhou¹,

Chen²,

Zheng³

et al. 2022

Echocardiography

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Background There are differences between young and older patients diagnosed with acute aortic dissection. We aimed to explore the differences in echocardiographic and computed tomography angiography (CTA) characteristics between the young and the older patients diagnosed with acute aortic dissection. Methods The data from 1220 patients with aortic dissection were collected. They were divided into the young and the older groups with the age threshold set at 45 years old. The basic information and imaging data were collected and compared between the two groups. Univariate regression was used to find the risk factors for mortality in each group. Results Echocardiographic results showed the proportion of left ventricular enlargement (young vs older, 39.9% vs 26.9%, p‐value <.001) and left ventricular dysfunction (22.3% vs 14.1%, p‐value smaller than .001) in the young group was significantly higher. Although there is no statistically significant difference in mortality within 60 days after admission (12.0% vs 15.1%, p‐value equals to .164), the involvements of aortic branches were the risk factor for the mortality in the young group. For the older patients, the left ventricular remodeling detected by echocardiography (left atrial enlargement, ascending aortic dilation, aortic regurgitation) and decreased heart function were the risk factors for mortality. Conclusions The mortality of the young and the older groups with acute aortic dissection are comparable. The involvements of aortic branches were the mortality risk factors in the young patients while the structural and functional change of the left ventricle detected by echocardiography was the mortality risk factor for the older patients.

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Age-related presentation of acute type A aortic dissection

Cited by 9 publications

References 22 publications

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

The impact of age and sex on in-hospital outcomes in acute type A aortic dissection surgery

Morbid obesity impacts mortality among inpatients with type a aortic dissection: an analysis of the national inpatient sample

Comparison of imaging characteristics for mortality risk analysis between young and older acute aortic dissection patients

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