The role of age in complicated acute type B aortic dissection.
BACKGROUND
Complicated acute type B aortic dissection (cABAD) generally requires urgent intervention. Advanced age is a risk factor for mortality after thoracic aortic intervention, including surgery for aortic dissection. The purpose of this study was to investigate the exact impact of increasing age on the management and outcomes of cABAD.


METHODS
We analyzed the outcomes of 583 patients with cABAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2012. All patients with cABAD were categorized according to age by decade and management type (medical, surgical, or endovascular treatment), and outcomes were subsequently investigated in the different age groups.


RESULTS
The mean age of the cohort was 63.4 ± 14.2 years, 36% of patients (n = 209) were greater than 70 years of age and 64% (n = 374) were less than 70 years. The utilization of surgery and endovascular techniques progressively decreased with patient age, while the rate of medical management significantly increased with age (p < 0.001). The in-hospital mortality rates for complicated patients younger than 70 years versus 70 years or more were 10.1% versus 30.0% for endovascular treatment (p = 0.001), 17.2% versus 34.2% for surgical treatment (p = 0.027), and 14.2% versus 32.2% for medical treatment (p = 0.001). Age 70 years or greater was a predictor of in-hospital mortality in multivariate analysis (odds ratio 2.37, 95% confidence interval: 1.23 to 4.54, p = 0.010).


CONCLUSIONS
Advanced age has a dramatic impact on the management and outcomes of patients with cABAD. A nonsignificant trend toward lower mortality after endovascular management was observed, both for younger patients and for elderly patients.
Thoracic Aortic Research Center, IRCCS Policlinico San Donato, San Donato, Italy. Electronic address: jonkerfrederik@hotmail.com.
Frederik H W
FH
Jonker
Santi
S
Trimarchi
Bart E
BE
Muhs
Vincenzo
V
Rampoldi
Daniel G
DG
Montgomery
James B
JB
Froehlich
Mark D
MD
Peterson
Kristian
K
Bartnes
Venu
V
Gourineni
Vijay S
VS
Ramanath
Alan C
AC
Braverman
Christoph A
CA
Nienaber
Eric M
EM
Isselbacher
Kim A
KA
Eagle
D000208:Acute Disease; D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000453:epidemiology* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000453:epidemiology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D014943:Global Health; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014656:Vascular Surgical Procedures / Q000379:methods*
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