Abstract
Background: Acute type A aortic dissection (aTAAD) is a lethal disease
and age is an important risk factor for outcomes. This retrospective
study was to analyze the impact of age stratification in aTAAD. Methods:
From January 2011 to December 2019, 1092 aTAAD patients from Nanjing
Drum Tower Hospital received surgical therapy. Patients were divided
into seven groups according to every ten-year interval (20s-80s). The
differences between the groups were analyzed in terms of the baseline
preoperative conditions, surgical methods, and postoperative outcomes of
patients of different age groups. During a median follow-up term of 17
months, the survival rates were compared among seven groups through
Kaplan-Meier analysis. Results: The median age was 52.0 years old in the
whole cohort. The multiple comorbidities were more common in old age
groups (60s, 70s, 80s), while the 20s group patients had the highest
proportion of Marfan syndrome (28.1%). Preoperative hypotension was
highest in 80s (16.7%, P=0.038). Young age groups (20s-60s) had a
higher rate of root replacement and total arch replacement, which led to
a longer duration of operation and hypothermic circulation arrest. The
overall mortality was 14.1%, the tendency of mortality was increased
with age except 20s group (33.3% in 80s, P=0.016). The postoperative
morbidity of gastrointestinal bleeding and bowel ischemia were 16.7%
and 11.1% in 80s group. Conclusion: Age is a major impact factor for
aTAAD surgery. Old patients presented more comorbidities before surgery,
the mortality and complications rate were significantly higher even with
less invasive and conservative surgical therapy.