Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)
Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair...
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| creator | Trimarchi, Santi, MD Eagle, Kim A., MD Nienaber, Christoph A., MD Rampoldi, Vincenzo, MD Jonker, Frederik H.W., MD De Vincentiis, Carlo, MD Frigiola, Alessandro, MD Menicanti, Lorenzo, MD Tsai, Thomas, MD Froehlich, Jim, MD Evangelista, Arturo, MD Montgomery, Daniel, MD Bossone, Eduardo, MD Cooper, Jeanna V., MS Li, Jin, MS Deeb, Michael G., MD Meinhardt, Gabriel, MD Sundt, Thoralf M., MD Isselbacher, Eric M., MD |
| description | Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection. Methods We analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group. Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age. |
| doi_str_mv | 10.1016/j.jtcvs.2009.11.014 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_755172256</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><els_id>1_s2_0_S002252230901469X</els_id><sourcerecordid>755172256</sourcerecordid><originalsourceid>FETCH-LOGICAL-c554t-a2f34af18ddfce07cbad7ea423c6ec5fd3df0f6a6d3ab3fd81c1b8e170e5b1d93</originalsourceid><addsrcrecordid>eNqFkkuLFDEURoMoTs_oLxAkG1EXVeZRT0GhmPHRMCC0CrMLqeRmTFldaZPUQK_mr5uabh1w4yqLe74v4eQi9IySnBJavRnyIaqbkDNC2pzSnNDiAVpR0tZZ1ZRXD9GKEMaykjF-gk5DGAghNaHtY3TCCK0rXrMVut24EbAzWF4DthOWao6A434HuMPS-WgV1jYEUNG6Cbs5KreFt3gDuzTExrstjj8Ar6cIfpILJMc0vbYh-v1S3N01doeqi_uqV-tNd_H6CXpk5Bjg6fE8Q98_fvh2_jm7_PJpfd5dZqosi5hJZnghDW20NgpIrXqpa5AF46oCVRrNtSGmkpXmsudGN1TRvgFaEyh7qlt-hl4eenfe_ZohRLG1QcE4ygncHERdlrRmrKwSyQ-k8i4ED0bsvN1KvxeUiEW8GMSdeLGIF5SKJD6lnh_7534L-m_mj-kEvDgCMig5Gi8nZcM9x1lDirpM3LsDB8nGjQUvgrIwKdDWJ3NCO_ufh7z_J69GO9l05U_YQxjcnL5pDIKKwAQRX5cdWVaEtCldtVf8N1KMuVg</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>755172256</pqid></control><display><type>article</type><title>Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)</title><source>MEDLINE</source><source>Elsevier ScienceDirect Journals</source><source>Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals</source><creator>Trimarchi, Santi, MD ; Eagle, Kim A., MD ; Nienaber, Christoph A., MD ; Rampoldi, Vincenzo, MD ; Jonker, Frederik H.W., MD ; De Vincentiis, Carlo, MD ; Frigiola, Alessandro, MD ; Menicanti, Lorenzo, MD ; Tsai, Thomas, MD ; Froehlich, Jim, MD ; Evangelista, Arturo, MD ; Montgomery, Daniel, MD ; Bossone, Eduardo, MD ; Cooper, Jeanna V., MS ; Li, Jin, MS ; Deeb, Michael G., MD ; Meinhardt, Gabriel, MD ; Sundt, Thoralf M., MD ; Isselbacher, Eric M., MD</creator><creatorcontrib>Trimarchi, Santi, MD ; Eagle, Kim A., MD ; Nienaber, Christoph A., MD ; Rampoldi, Vincenzo, MD ; Jonker, Frederik H.W., MD ; De Vincentiis, Carlo, MD ; Frigiola, Alessandro, MD ; Menicanti, Lorenzo, MD ; Tsai, Thomas, MD ; Froehlich, Jim, MD ; Evangelista, Arturo, MD ; Montgomery, Daniel, MD ; Bossone, Eduardo, MD ; Cooper, Jeanna V., MS ; Li, Jin, MS ; Deeb, Michael G., MD ; Meinhardt, Gabriel, MD ; Sundt, Thoralf M., MD ; Isselbacher, Eric M., MD ; International Registry of Acute Aortic Dissection (IRAD) Investigators ; International Registry of Acute Aortic Dissection Investigators</creatorcontrib><description>Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection. Methods We analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group. Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age.</description><identifier>ISSN: 0022-5223</identifier><identifier>EISSN: 1097-685X</identifier><identifier>DOI: 10.1016/j.jtcvs.2009.11.014</identifier><identifier>PMID: 20176372</identifier><identifier>CODEN: JTCSAQ</identifier><language>eng</language><publisher>New York, NY: Mosby, Inc</publisher><subject>Acute Disease ; Age Factors ; Aged ; Aged, 80 and over ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Aneurysm, Dissecting - mortality ; Aneurysm, Dissecting - therapy ; Aortic Aneurysm - mortality ; Aortic Aneurysm - therapy ; Asia ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Cardiothoracic Surgery ; Cardiovascular Agents - therapeutic use ; Chi-Square Distribution ; Diseases of the aorta ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Europe ; Hospital Mortality ; Humans ; Medical sciences ; Odds Ratio ; Patient Selection ; Pneumology ; Registries ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Treatment Outcome ; United States ; Vascular Surgical Procedures - adverse effects ; Vascular Surgical Procedures - mortality</subject><ispartof>The Journal of thoracic and cardiovascular surgery, 2010-10, Vol.140 (4), p.784-789</ispartof><rights>The American Association for Thoracic Surgery</rights><rights>2010 The American Association for Thoracic Surgery</rights><rights>2015 INIST-CNRS</rights><rights>Copyright © 2010 The American Association for Thoracic Surgery. Published by Mosby, Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c554t-a2f34af18ddfce07cbad7ea423c6ec5fd3df0f6a6d3ab3fd81c1b8e170e5b1d93</citedby><cites>FETCH-LOGICAL-c554t-a2f34af18ddfce07cbad7ea423c6ec5fd3df0f6a6d3ab3fd81c1b8e170e5b1d93</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/S002252230901469X$$EHTML$$P50$$Gelsevier$$Hfree_for_read</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=23280475$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20176372$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Trimarchi, Santi, MD</creatorcontrib><creatorcontrib>Eagle, Kim A., MD</creatorcontrib><creatorcontrib>Nienaber, Christoph A., MD</creatorcontrib><creatorcontrib>Rampoldi, Vincenzo, MD</creatorcontrib><creatorcontrib>Jonker, Frederik H.W., MD</creatorcontrib><creatorcontrib>De Vincentiis, Carlo, MD</creatorcontrib><creatorcontrib>Frigiola, Alessandro, MD</creatorcontrib><creatorcontrib>Menicanti, Lorenzo, MD</creatorcontrib><creatorcontrib>Tsai, Thomas, MD</creatorcontrib><creatorcontrib>Froehlich, Jim, MD</creatorcontrib><creatorcontrib>Evangelista, Arturo, MD</creatorcontrib><creatorcontrib>Montgomery, Daniel, MD</creatorcontrib><creatorcontrib>Bossone, Eduardo, MD</creatorcontrib><creatorcontrib>Cooper, Jeanna V., MS</creatorcontrib><creatorcontrib>Li, Jin, MS</creatorcontrib><creatorcontrib>Deeb, Michael G., MD</creatorcontrib><creatorcontrib>Meinhardt, Gabriel, MD</creatorcontrib><creatorcontrib>Sundt, Thoralf M., MD</creatorcontrib><creatorcontrib>Isselbacher, Eric M., MD</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection (IRAD) Investigators</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection Investigators</creatorcontrib><title>Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)</title><title>The Journal of thoracic and cardiovascular surgery</title><addtitle>J Thorac Cardiovasc Surg</addtitle><description>Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection. Methods We analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group. Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age.</description><subject>Acute Disease</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Aneurysm, Dissecting - mortality</subject><subject>Aneurysm, Dissecting - therapy</subject><subject>Aortic Aneurysm - mortality</subject><subject>Aortic Aneurysm - therapy</subject><subject>Asia</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Cardiothoracic Surgery</subject><subject>Cardiovascular Agents - therapeutic use</subject><subject>Chi-Square Distribution</subject><subject>Diseases of the aorta</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Europe</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Medical sciences</subject><subject>Odds Ratio</subject><subject>Patient Selection</subject><subject>Pneumology</subject><subject>Registries</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Treatment Outcome</subject><subject>United States</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - mortality</subject><issn>0022-5223</issn><issn>1097-685X</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2010</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqFkkuLFDEURoMoTs_oLxAkG1EXVeZRT0GhmPHRMCC0CrMLqeRmTFldaZPUQK_mr5uabh1w4yqLe74v4eQi9IySnBJavRnyIaqbkDNC2pzSnNDiAVpR0tZZ1ZRXD9GKEMaykjF-gk5DGAghNaHtY3TCCK0rXrMVut24EbAzWF4DthOWao6A434HuMPS-WgV1jYEUNG6Cbs5KreFt3gDuzTExrstjj8Ar6cIfpILJMc0vbYh-v1S3N01doeqi_uqV-tNd_H6CXpk5Bjg6fE8Q98_fvh2_jm7_PJpfd5dZqosi5hJZnghDW20NgpIrXqpa5AF46oCVRrNtSGmkpXmsudGN1TRvgFaEyh7qlt-hl4eenfe_ZohRLG1QcE4ygncHERdlrRmrKwSyQ-k8i4ED0bsvN1KvxeUiEW8GMSdeLGIF5SKJD6lnh_7534L-m_mj-kEvDgCMig5Gi8nZcM9x1lDirpM3LsDB8nGjQUvgrIwKdDWJ3NCO_ufh7z_J69GO9l05U_YQxjcnL5pDIKKwAQRX5cdWVaEtCldtVf8N1KMuVg</recordid><startdate>20101001</startdate><enddate>20101001</enddate><creator>Trimarchi, Santi, MD</creator><creator>Eagle, Kim A., MD</creator><creator>Nienaber, Christoph A., MD</creator><creator>Rampoldi, Vincenzo, MD</creator><creator>Jonker, Frederik H.W., MD</creator><creator>De Vincentiis, Carlo, MD</creator><creator>Frigiola, Alessandro, MD</creator><creator>Menicanti, Lorenzo, MD</creator><creator>Tsai, Thomas, MD</creator><creator>Froehlich, Jim, MD</creator><creator>Evangelista, Arturo, MD</creator><creator>Montgomery, Daniel, MD</creator><creator>Bossone, Eduardo, MD</creator><creator>Cooper, Jeanna V., MS</creator><creator>Li, Jin, MS</creator><creator>Deeb, Michael G., MD</creator><creator>Meinhardt, Gabriel, MD</creator><creator>Sundt, Thoralf M., MD</creator><creator>Isselbacher, Eric M., MD</creator><general>Mosby, Inc</general><general>Elsevier</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20101001</creationdate><title>Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)</title><author>Trimarchi, Santi, MD ; Eagle, Kim A., MD ; Nienaber, Christoph A., MD ; Rampoldi, Vincenzo, MD ; Jonker, Frederik H.W., MD ; De Vincentiis, Carlo, MD ; Frigiola, Alessandro, MD ; Menicanti, Lorenzo, MD ; Tsai, Thomas, MD ; Froehlich, Jim, MD ; Evangelista, Arturo, MD ; Montgomery, Daniel, MD ; Bossone, Eduardo, MD ; Cooper, Jeanna V., MS ; Li, Jin, MS ; Deeb, Michael G., MD ; Meinhardt, Gabriel, MD ; Sundt, Thoralf M., MD ; Isselbacher, Eric M., MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c554t-a2f34af18ddfce07cbad7ea423c6ec5fd3df0f6a6d3ab3fd81c1b8e170e5b1d93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2010</creationdate><topic>Acute Disease</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Aneurysm, Dissecting - mortality</topic><topic>Aneurysm, Dissecting - therapy</topic><topic>Aortic Aneurysm - mortality</topic><topic>Aortic Aneurysm - therapy</topic><topic>Asia</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Cardiothoracic Surgery</topic><topic>Cardiovascular Agents - therapeutic use</topic><topic>Chi-Square Distribution</topic><topic>Diseases of the aorta</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Europe</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Medical sciences</topic><topic>Odds Ratio</topic><topic>Patient Selection</topic><topic>Pneumology</topic><topic>Registries</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Treatment Outcome</topic><topic>United States</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - mortality</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Trimarchi, Santi, MD</creatorcontrib><creatorcontrib>Eagle, Kim A., MD</creatorcontrib><creatorcontrib>Nienaber, Christoph A., MD</creatorcontrib><creatorcontrib>Rampoldi, Vincenzo, MD</creatorcontrib><creatorcontrib>Jonker, Frederik H.W., MD</creatorcontrib><creatorcontrib>De Vincentiis, Carlo, MD</creatorcontrib><creatorcontrib>Frigiola, Alessandro, MD</creatorcontrib><creatorcontrib>Menicanti, Lorenzo, MD</creatorcontrib><creatorcontrib>Tsai, Thomas, MD</creatorcontrib><creatorcontrib>Froehlich, Jim, MD</creatorcontrib><creatorcontrib>Evangelista, Arturo, MD</creatorcontrib><creatorcontrib>Montgomery, Daniel, MD</creatorcontrib><creatorcontrib>Bossone, Eduardo, MD</creatorcontrib><creatorcontrib>Cooper, Jeanna V., MS</creatorcontrib><creatorcontrib>Li, Jin, MS</creatorcontrib><creatorcontrib>Deeb, Michael G., MD</creatorcontrib><creatorcontrib>Meinhardt, Gabriel, MD</creatorcontrib><creatorcontrib>Sundt, Thoralf M., MD</creatorcontrib><creatorcontrib>Isselbacher, Eric M., MD</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection (IRAD) Investigators</creatorcontrib><creatorcontrib>International Registry of Acute Aortic Dissection Investigators</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Trimarchi, Santi, MD</au><au>Eagle, Kim A., MD</au><au>Nienaber, Christoph A., MD</au><au>Rampoldi, Vincenzo, MD</au><au>Jonker, Frederik H.W., MD</au><au>De Vincentiis, Carlo, MD</au><au>Frigiola, Alessandro, MD</au><au>Menicanti, Lorenzo, MD</au><au>Tsai, Thomas, MD</au><au>Froehlich, Jim, MD</au><au>Evangelista, Arturo, MD</au><au>Montgomery, Daniel, MD</au><au>Bossone, Eduardo, MD</au><au>Cooper, Jeanna V., MS</au><au>Li, Jin, MS</au><au>Deeb, Michael G., MD</au><au>Meinhardt, Gabriel, MD</au><au>Sundt, Thoralf M., MD</au><au>Isselbacher, Eric M., MD</au><aucorp>International Registry of Acute Aortic Dissection (IRAD) Investigators</aucorp><aucorp>International Registry of Acute Aortic Dissection Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD)</atitle><jtitle>The Journal of thoracic and cardiovascular surgery</jtitle><addtitle>J Thorac Cardiovasc Surg</addtitle><date>2010-10-01</date><risdate>2010</risdate><volume>140</volume><issue>4</issue><spage>784</spage><epage>789</epage><pages>784-789</pages><issn>0022-5223</issn><eissn>1097-685X</eissn><coden>JTCSAQ</coden><abstract>Objective The increasing life expectancy of the population will likely be accompanied by a rise in the incidence of acute type A aortic dissection. However, because of an increased risk of cardiac surgery in an elderly population, it is important to define when, if at all, the risks of aortic repair outweigh the risk of death from unoperated type A aortic dissection. Methods We analyzed 936 patients with type A aortic dissection enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2004. Patients with type A aortic dissection were categorized according to patient age by decade and by surgical versus medical management, and outcomes of both management types were investigated in the different age groups. Results The rate of surgical aortic repair decreased progressively with age, whereas surgical mortality significantly increased with age. Age 70 years or more was an independent predictor for mortality (38.2% vs 26.0%; P < .0001, odds ratio 1.73). The in-hospital mortality rate was significantly lower after surgical management compared with medical management until the age of 80 years. For patients aged 80 to 90 years, the in-hospital mortality appeared to be lower after surgical management (37.9% vs 55.2%; P = .188); however, this failed to reach clinical significance owing to the limited patient number in this age group. Conclusions Although the surgical mortality significantly increased with increased age, surgical management was still associated with significantly lower in-hospital mortality rates compared with medical management until the age of 80 years. Surgery may decrease the in-hospital mortality rate for octogenarians with type A aortic dissection and might be considered in all patients with type A aortic dissection regardless of age.</abstract><cop>New York, NY</cop><pub>Mosby, Inc</pub><pmid>20176372</pmid><doi>10.1016/j.jtcvs.2009.11.014</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Age Factors Aged Aged, 80 and over Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Aneurysm, Dissecting - mortality Aneurysm, Dissecting - therapy Aortic Aneurysm - mortality Aortic Aneurysm - therapy Asia Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Cardiothoracic Surgery Cardiovascular Agents - therapeutic use Chi-Square Distribution Diseases of the aorta Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Europe Hospital Mortality Humans Medical sciences Odds Ratio Patient Selection Pneumology Registries Retrospective Studies Risk Assessment Risk Factors Time Factors Treatment Outcome United States Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - mortality |
| title | Role of age in acute type A aortic dissection outcome: Report from the International Registry of Acute Aortic Dissection (IRAD) |
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