Acute type A aortic dissection in adolescents and young adults under 30 years of age: demographics, aetiology and postoperative outcomes of 139 cases

Abstract

Background The prevalence and etiology of acute aortic dissection type A in patients ≤30 years is unknown. The aims of this clinical study were to determine the prevalence and potential etiology of acute aortic dissection type A in surgically treated patients ≤30 years and to evaluate the respective postoperative outcomes in this selective group of patients in a large multi-centre study. Methods Retrospective data collection was performed at the 16 participating international aortic institutions. All patients ≤30years at the time of dissection onset were included. The postoperative results were analysed with regard to connective tissue disease. Results The overall prevalence of acute aortic dissection type A ≤ 30years was 1.8% (139 out of 7914 patients), including 51(36.7%) patients who were retrospectively diagnosed with connective tissue disease. Cumulative postoperative mortality was 8.6%, 2.2% and 1.4%, respectively. Actuarial survival was 80% at 10 years postoperatively. Non- connective tissue disease patients (n = 88) had a significantly higher incidence of arterial hypertension (46.6%vs.9.8%;p<0.001) while acute aortic dissection type A affected the aortic root (p < 0.001) and arch (p = 0.029) significantly more often in the connective tissue disease group. A positive family history of aortic disease was present in 9.4% of the study cohort(n = 13). Conclusions The prevalence of acute aortic dissection type A in surgically treated patients ≤30 years is less than 2% with connective tissue disease and arterial hypertension as the two most prevalent triggers of acute aortic dissection type A. Open surgery may be performed with good early results and excellent mid- to long-term outcomes.

Comparative Study of Male and Female Patients Undergoing Frozen Elephant Trunk Total Arch Replacement

“…The cut-off for a balanced gender distribution in type A dissection seems to be around 75 years [14]. This is in line with a recent paper investigating type A dissections in young adults under 30 years of age, presenting with 75% male patients [15]. In our cohort, male patients required emergency operation for acute type A or type B dissection significantly more often.…”