Early- and Long-Term Outcomes After Surgery for Acute Type A Aortic Dissection in Patients Aged 45 Years and Younger
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. Methods and Results: Subjects were 355 patients who had undergone emergency surgery for AAAD. The patients were grouped as...
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| Veröffentlicht in: | Circulation Journal 2011, Vol.75(9), pp.2135-2143 |
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| creator | Kimura, Naoyuki Tanaka, Masashi Kawahito, Koji Itoh, Satoshi Okamura, Homare Yamaguchi, Atsushi Ino, Takashi Adachi, Hideo |
| description | 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. Methods and 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%, P45mm (P |
| doi_str_mv | 10.1253/circj.CJ-10-1222 |
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The early- and long-term outcomes after surgery for AAAD in patients aged ≤45 years was investigated. Methods and 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 >45mm (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. (Circ J 2011; 75: 2135-2143)</description><identifier>ISSN: 1346-9843</identifier><identifier>EISSN: 1347-4820</identifier><identifier>DOI: 10.1253/circj.CJ-10-1222</identifier><identifier>PMID: 21712608</identifier><language>eng</language><publisher>Japan: The Japanese Circulation Society</publisher><subject>Acute Disease ; Adult ; Age Factors ; Aged ; Aorta ; Aorta - surgery ; Aortic Diseases - etiology ; Aortic Diseases - mortality ; Aortic Diseases - surgery ; Aortic Valve Insufficiency ; Disease-Free Survival ; Dissection ; Female ; Hospital Mortality ; Humans ; Male ; Marfan Syndrome - complications ; Marfan Syndrome - mortality ; Marfan Syndrome - surgery ; Middle Aged ; Reoperation ; Retrospective Studies ; Rupture, Spontaneous - etiology ; Rupture, Spontaneous - mortality ; Rupture, Spontaneous - surgery ; Sex Factors ; Survival Rate ; Time Factors ; Young</subject><ispartof>Circulation Journal, 2011, Vol.75(9), pp.2135-2143</ispartof><rights>2011 THE JAPANESE CIRCULATION SOCIETY</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c594t-c95bb6a7c39051e13e798445258a8ab37fd79e50791bba755fc2733857f688f53</citedby><cites>FETCH-LOGICAL-c594t-c95bb6a7c39051e13e798445258a8ab37fd79e50791bba755fc2733857f688f53</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,1877,4010,27900,27901,27902</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21712608$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Kimura, Naoyuki</creatorcontrib><creatorcontrib>Tanaka, Masashi</creatorcontrib><creatorcontrib>Kawahito, Koji</creatorcontrib><creatorcontrib>Itoh, Satoshi</creatorcontrib><creatorcontrib>Okamura, Homare</creatorcontrib><creatorcontrib>Yamaguchi, Atsushi</creatorcontrib><creatorcontrib>Ino, Takashi</creatorcontrib><creatorcontrib>Adachi, Hideo</creatorcontrib><title>Early- and Long-Term Outcomes After Surgery for Acute Type A Aortic Dissection in Patients Aged 45 Years and Younger</title><title>Circulation Journal</title><addtitle>Circ J</addtitle><description>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. Methods and 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 >45mm (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. (Circ J 2011; 75: 2135-2143)</description><subject>Acute Disease</subject><subject>Adult</subject><subject>Age Factors</subject><subject>Aged</subject><subject>Aorta</subject><subject>Aorta - surgery</subject><subject>Aortic Diseases - etiology</subject><subject>Aortic Diseases - mortality</subject><subject>Aortic Diseases - surgery</subject><subject>Aortic Valve Insufficiency</subject><subject>Disease-Free Survival</subject><subject>Dissection</subject><subject>Female</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Male</subject><subject>Marfan Syndrome - complications</subject><subject>Marfan Syndrome - mortality</subject><subject>Marfan Syndrome - surgery</subject><subject>Middle Aged</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Rupture, Spontaneous - etiology</subject><subject>Rupture, Spontaneous - mortality</subject><subject>Rupture, Spontaneous - surgery</subject><subject>Sex Factors</subject><subject>Survival Rate</subject><subject>Time Factors</subject><subject>Young</subject><issn>1346-9843</issn><issn>1347-4820</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkM1v2yAYh1G1qu263nuauO1Ey4cxcLSytGsVqZOWHXpCmLzOHNkmA3zIf1_no-0FEHp-zws_hG4ZvWNcinvfRr-5mz0TRgnjnJ-hKyYKRQrN6ZfDuSRGF-ISfU1pQyk3VJoLdMmZYryk-grluYvdjmA3rPAiDGuyhNjjlzH70EPCVZMh4j9jXEPc4SZEXPkxA17utoArXIWYW49_timBz20YcDvg3y63MOQpvIYVLiR-BRfTYcJrGIfJ9A2dN65LcHPar9Hfh_ly9ossXh6fZtWCeGmKTLyRdV065cX0bAZMgJo-U0gutdOuFqpZKQOSKsPq2ikpG8-VEFqqptS6keIa_Th6tzH8HyFl27fJQ9e5AcKYrNZSlkKaPUmPpI8hpQiN3ca2d3FnGbX7qu2hajt7Pl5wPkW-n-Rj3cPqI_De7QQ8HIFNym4NH4Dbd9bByaikNfvl0_wJ_HPRwiDeACU6kvQ</recordid><startdate>2011</startdate><enddate>2011</enddate><creator>Kimura, Naoyuki</creator><creator>Tanaka, Masashi</creator><creator>Kawahito, Koji</creator><creator>Itoh, Satoshi</creator><creator>Okamura, Homare</creator><creator>Yamaguchi, Atsushi</creator><creator>Ino, Takashi</creator><creator>Adachi, Hideo</creator><general>The Japanese Circulation Society</general><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>2011</creationdate><title>Early- and Long-Term Outcomes After Surgery for Acute Type A Aortic Dissection in Patients Aged 45 Years and Younger</title><author>Kimura, Naoyuki ; Tanaka, Masashi ; Kawahito, Koji ; Itoh, Satoshi ; Okamura, Homare ; Yamaguchi, Atsushi ; Ino, Takashi ; Adachi, Hideo</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c594t-c95bb6a7c39051e13e798445258a8ab37fd79e50791bba755fc2733857f688f53</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>Acute Disease</topic><topic>Adult</topic><topic>Age Factors</topic><topic>Aged</topic><topic>Aorta</topic><topic>Aorta - surgery</topic><topic>Aortic Diseases - etiology</topic><topic>Aortic Diseases - mortality</topic><topic>Aortic Diseases - surgery</topic><topic>Aortic Valve Insufficiency</topic><topic>Disease-Free Survival</topic><topic>Dissection</topic><topic>Female</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Male</topic><topic>Marfan Syndrome - complications</topic><topic>Marfan Syndrome - mortality</topic><topic>Marfan Syndrome - surgery</topic><topic>Middle Aged</topic><topic>Reoperation</topic><topic>Retrospective Studies</topic><topic>Rupture, Spontaneous - etiology</topic><topic>Rupture, Spontaneous - mortality</topic><topic>Rupture, Spontaneous - surgery</topic><topic>Sex Factors</topic><topic>Survival Rate</topic><topic>Time Factors</topic><topic>Young</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Kimura, Naoyuki</creatorcontrib><creatorcontrib>Tanaka, Masashi</creatorcontrib><creatorcontrib>Kawahito, Koji</creatorcontrib><creatorcontrib>Itoh, Satoshi</creatorcontrib><creatorcontrib>Okamura, Homare</creatorcontrib><creatorcontrib>Yamaguchi, Atsushi</creatorcontrib><creatorcontrib>Ino, Takashi</creatorcontrib><creatorcontrib>Adachi, Hideo</creatorcontrib><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>Circulation Journal</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Kimura, Naoyuki</au><au>Tanaka, Masashi</au><au>Kawahito, Koji</au><au>Itoh, Satoshi</au><au>Okamura, Homare</au><au>Yamaguchi, Atsushi</au><au>Ino, Takashi</au><au>Adachi, Hideo</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Early- and Long-Term Outcomes After Surgery for Acute Type A Aortic Dissection in Patients Aged 45 Years and Younger</atitle><jtitle>Circulation Journal</jtitle><addtitle>Circ J</addtitle><date>2011</date><risdate>2011</risdate><volume>75</volume><issue>9</issue><spage>2135</spage><epage>2143</epage><pages>2135-2143</pages><issn>1346-9843</issn><eissn>1347-4820</eissn><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. Methods and 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 >45mm (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. (Circ J 2011; 75: 2135-2143)</abstract><cop>Japan</cop><pub>The Japanese Circulation Society</pub><pmid>21712608</pmid><doi>10.1253/circj.CJ-10-1222</doi><tpages>9</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Acute Disease Adult Age Factors Aged Aorta Aorta - surgery Aortic Diseases - etiology Aortic Diseases - mortality Aortic Diseases - surgery Aortic Valve Insufficiency Disease-Free Survival Dissection Female Hospital Mortality Humans Male Marfan Syndrome - complications Marfan Syndrome - mortality Marfan Syndrome - surgery Middle Aged Reoperation Retrospective Studies Rupture, Spontaneous - etiology Rupture, Spontaneous - mortality Rupture, Spontaneous - surgery Sex Factors Survival Rate Time Factors Young |
| title | Early- and Long-Term Outcomes After Surgery for Acute Type A Aortic Dissection in Patients Aged 45 Years and Younger |
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