title: Acute aortic dissection type A: age-related management and outcomes reported in the German Registry for Acute Aortic Dissection Type A (GERAADA) of over 2000 patients.
abstract: OBJECTIVE
  To determine the association between age and clinical presentation, management and surgical outcomes in a large contemporary, prospective cohort of patients with acute aortic dissection type A (AADA).
  
  
  BACKGROUND
  AADA is one of the most life-threatening cardiovascular diseases, and delayed surgery or overly conservative management can result in sudden death.
  
  
  METHODS
  The perioperative and intraoperative conditions of 2137 patients prospectively reported to the multicenter German Registry for Acute Aortic Dissection Type A were analyzed.
  
  
  RESULTS
  Of all patients with AADA, 640 (30%) were 70 years or older and 160 patients (7%) were younger than 40 years. The probability of aortic dissection extension to the supra-aortic vessels and abdominal aorta decreased with age (P < 0.0001 and P = 0.0017, respectively). In 1447 patients (69%), the aortic root was preserved and supracoronary replacement of the ascending aorta was done. The probability of this procedure increased with age (P < 0.0001). The incidence of new postoperative neurological disorders was not influenced by age. The lowest probability of 30-day mortality was noted in the youngest patients (11%-14% for patients aged between 20 and 40 years) and rose progressively with age, peaking at 25% in octogenarians.
  
  
  CONCLUSIONS
  This study reflects current results after surgical treatment of AADA in relation to patient age. Current survival rates are acceptable, even in very elderly patients. The contemporary surgical mortality rate among young patients is lower than that previously reported in the literature. The postoperative stroke incidence does not increase with age.
authors: *University Heart Center Freiburg, Freiburg, Germany †Institute for Medical Biostatistics, Epidemiology and Informatics, Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany ‡Department of Cardiac Surgery, Leipzig Heart Center, Leipzig, Germany §Department for Cardiothoracic and Vascular Surgery, Medical Center of Johannes Gutenberg-University Mainz, Mainz, Germany.
authors: Bartosz
authors: B
authors: Rylski
authors: Isabell
authors: I
authors: Hoffmann
authors: Friedhelm
authors: F
authors: Beyersdorf
authors: Michael
authors: M
authors: Suedkamp
authors: Matthias
authors: M
authors: Siepe
authors: Brigitte
authors: B
authors: Nitsch
authors: Maria
authors: M
authors: Blettner
authors: Michael Andrew
authors: MA
authors: Borger
authors: Ernst
authors: E
authors: Weigang
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology / Q000601:surgery*; D017544:Aortic Aneurysm, Abdominal / Q000453:epidemiology / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology / Q000601:surgery*; D001317:Austria / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D011446:Prospective Studies; D012042:Registries; D012737:Sex Factors; D015996:Survival Rate / Q000639:trends; D013557:Switzerland / Q000453:epidemiology; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult