Acute Type A Aortic Dissection in Adolescents and Young Adults under 30 Years of Age: Demographics, Etiology and Postoperative Outcomes of 139 cases.

Luehr, Maximilian; Yildiz, Murat; Ma, Wei-Guo; Heck, Roland; Polycarpou, Andreas; Jassar, Arminder; Kreibich, Maximilian; Dohle, Daniel-Sebastian; Weiss, Gabriel; Hagl, Christian; Rega, Filip; Schachner, Thomas; Martens, Andreas; Della Corte, Alessandro; Osada, Hiroaki; Sun, Li-Zhong; Tsagakis, Konstantinos; Schoenhoff, Florian (2023). Acute Type A Aortic Dissection in Adolescents and Young Adults under 30 Years of Age: Demographics, Etiology and Postoperative Outcomes of 139 cases. European journal of cardio-thoracic surgery, 63(5) Oxford University Press 10.1093/ejcts/ezad112

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BACKGROUND

The prevalence and etiology of acute aortic dissection type A in patients ≤30 years is unknown. The aims of this clinical study were to determine the prevalence and potential etiology of acute aortic dissection type A in surgically treated patients ≤30 years and to evaluate the respective postoperative outcomes in this selective group of patients in a large multi-centre study.

METHODS

Retrospective data collection was performed at the 16 participating international aortic institutions. All patients ≤30years at the time of dissection onset were included. The postoperative results were analysed with regard to connective tissue disease.

RESULTS

The overall prevalence of acute aortic dissection type A ≤ 30years was 1.8% (139 out of 7914 patients), including 51(36.7%) patients who were retrospectively diagnosed with connective tissue disease. Cumulative postoperative mortality was 8.6%, 2.2% and 1.4%, respectively. Actuarial survival was 80% at 10 years postoperatively. Non- connective tissue disease patients (n = 88) had a significantly higher incidence of arterial hypertension (46.6%vs.9.8%;p<0.001) while acute aortic dissection type A affected the aortic root (p < 0.001) and arch (p = 0.029) significantly more often in the connective tissue disease group. A positive family history of aortic disease was present in 9.4% of the study cohort(n = 13).

CONCLUSIONS

The prevalence of acute aortic dissection type A in surgically treated patients ≤30 years is less than 2% with connective tissue disease and arterial hypertension as the two most prevalent triggers of acute aortic dissection type A. Open surgery may be performed with good early results and excellent mid- to long-term outcomes.

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