title: Early- and long-term outcomes after surgery for acute type a aortic dissection in patients aged 45 years and younger.
abstract: BACKGROUND
  Acute type A aortic dissection (AAAD) is rare in young people. The early- and long-term outcomes after surgery for AAAD in patients aged ≤ 45 years was investigated.
  
  
  RESULTS
  Subjects were 355 patients who had undergone emergency surgery for AAAD. The patients were grouped as those aged ≤ 45 years (n=30; mean age, 38.3 years; younger group) and those aged > 45 years (n = 325; mean age, 65.3 years; older group). Clinical and prognostic variables were compared between the groups. Male sex, Marfan syndrome, and severe aortic regurgitation were more prevalent in the younger group. In-hospital mortality (16.7% vs. 8.6%, P = 0.15) and postoperative patency of the distal aorta (90.8% vs. 59.1%, P < 0.01) were more frequent in the younger group. The leading causes of late death were aortic rupture in the younger group (75.0%) and malignancy in the older group (27.5%). Although actuarial survival at 10 years was similar (64.5% vs. 62.5%), freedom from aortic reoperation at 10 years was decreased in the younger group (49.4% vs. 85.0%, P = 0.012). A distal aorta > 45 mm (P<0.001), Marfan syndrome (P < 0.01), and age ≤ 45 years (P = 0.045) were shown to be independent risk factors for reoperation.
  
  
  CONCLUSIONS
  Early- and long-term surgical outcomes are not better for patients ≤ 45 years, and the risk for reoperation is high in this group. Careful follow up is important in young patients with AAAD.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, Japan. kimura-n@omiya.jichi.ac.jp
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Masashi
authors.initials: M
authors.lastname: Tanaka
authors.forename: Koji
authors.initials: K
authors.lastname: Kawahito
authors.forename: Satoshi
authors.initials: S
authors.lastname: Itoh
authors.forename: Homare
authors.initials: H
authors.lastname: Okamura
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000208:Acute Disease; D000328:Adult; D000367:Age Factors; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001018:Aortic Diseases / Q000209:etiology / Q000401:mortality* / Q000601:surgery*; D001022:Aortic Valve Insufficiency; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000150:complications / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D012422:Rupture, Spontaneous / Q000209:etiology / Q000401:mortality / Q000601:surgery; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors