Type A aortic dissection in the elderly: One additional reason to pursue healthy ageing

2021 ◽  
Author(s):  
Andrea Amabile ◽  
Arnar Geirsson
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Healthy Ageing ◽  
Type A Aortic Dissection ◽  
Additional Reason

scholarly journals 293 * EARLY AND LATE OUTCOME AFTER SURGERY FOR ACUTE TYPE A AORTIC DISSECTION IN THE ELDERLY

2014 ◽  
Vol 19 (suppl 1) ◽  
pp. S88-S88
Author(s):  
P. G. Malvindi ◽  
A. Modi ◽  
S. Miskolczi ◽  
S. K. Ohri ◽  
C. W. Barlow ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Late Outcome ◽  
Type A Aortic Dissection

scholarly journals Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era

2002 ◽  
Vol 40 (4) ◽  
pp. 685-692 ◽  
Author(s):  
Rajendra H. Mehta ◽  
Patrick T. O’Gara ◽  
Eduardo Bossone ◽  
Christoph A. Nienaber ◽  
Truls Myrmel ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Clinical Characteristics ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Age-dependent differences in the prognostic relevance of body composition-related variables in type A aortic dissection patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Zeng-Rong Luo ◽  
Xiao-Dong Chen ◽  
Liang-wan Chen
Keyword(s):  
Body Composition ◽  
Aortic Dissection ◽  
Body Mass ◽  
Age Groups ◽  
Type A ◽  
The Elderly ◽  
Young Group ◽  
Type A Aortic Dissection ◽  
Cumulative Mortality ◽  
Cox Proportional Hazard

Abstract Background The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results Overall, 258 patients (53.9 ± 11.1 years old; 72.9% male) were separated into young (n = 110) and elderly (n = 148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p = 0.042), BMI ≤ 18.5 kg/m2 (p = 0.025), and lower LBM index values (p = 0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

scholarly journals Optimal Degree of Hypothermia in Total Arch Replacement for Type A Aortic Dissection

2021 ◽  
Vol 8 ◽  
Author(s):  
Jinlin Wu ◽  
Juntao Qiu ◽  
Zhongrong Fang ◽  
Qipeng Luo ◽  
Yao Huang ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Odds Ratio ◽  
Type A ◽  
The Elderly ◽  
Total Arch Replacement ◽  
Sensitivity Analyses ◽  
Paradigm Change ◽  
Type A Aortic Dissection ◽  
Primary Endpoints ◽  
Significant Protective Effect

Background: We sought to investigate the best degree of hypothermic cardiac arrest (HCA) in type A aortic dissection (TAAD) with a cohort of 1,018 cases receiving total arch replacement from 2013 to 2018 in Fuwai Hospital.Method: The cohort was divided by DHCA (≤24°C, n = 580) vs. MHCA (>24°C, n = 438), and interquartile range (Q1–Q4). Primary endpoints included mortality, stroke, paraplegia, and continuous renal replacement therapy (CRRT), which were summarized as composite major outcomes (CMO).Results: The Odds Ratio (OR) of CMO for MHCA was 0.7 (95% CI: 0.5–1.0, p = 0.06) (unadjusted) and 0.6 (95% CI: 0.4–1.0, p = 0.055) (adjusted). DHCA group tended to have a significantly longer CPB time (175.6 ± 45.6 vs. 166.8 ± 49.8 min, p = 0.003), longer hospital stay (16.0 ± 13.6 vs. 13.5 ± 6.8 days, p < 0.001), and ICU stay [5.0 (3.9–6.6) vs. 3.8 (2.0–5.6) days]. A significantly greater blood loss was observed in DHCA group, with a greater requirement for RBC and platelet transfusion. Of note, MHCA showed a significant protective effect (60% risk reduction) for older patients (above 60 years) (OR 0.4; 95% CI: 0.2–0.8; p = 0.009). By quartering, Q1 had significantly higher mortality (10.9%) than Q4 (5.2%) (p = 0.035). For other comparisons, the gap was significantly widened in quartering between Q1 and Q4, i.e., the lower the temperature, the worse the outcomes, and vice versa. Propensity score matching and sensitivity analyses confirmed the above findings.Conclusions: A paradigm change from DHCA to MHCA may be encouraged in TAAD arch operation, especially for the elderly.

scholarly journals Age-Dependent Differences in the Prognostic Relevance of Body Composition-Related Variables in Type a Aortic Dissection Patients

2021 ◽  
Author(s):  
Zeng-Rong Luo ◽  
Xiao-Dong Chen ◽  
Liang-wan Chen
Keyword(s):  
Body Composition ◽  
Aortic Dissection ◽  
Body Mass ◽  
Age Groups ◽  
Type A ◽  
The Elderly ◽  
Young Group ◽  
Type A Aortic Dissection ◽  
Cumulative Mortality ◽  
Cox Proportional Hazard

Abstract Background: The current research is allocated to appraise the association between the parameters of body composition and findings in type A aortic dissection (TAAD) cases in diverse age groups. Methods: Data from consecutive TAAD patients undergoing implantation of modified triple-branched stent-graft from January 2017 and December 2019 were prospectively collected and analyzed. A regression model of Cox proportional hazard was employed to assess correlations among body composition-related variables (body mass index [BMI], lean body mass [LBM], body surface area [BSA], and LBM index) as well as cumulative mortality. Results: Overall, 258 patients (53.9±11.1 years old; 72.9% male) were separated into young (n=110) and elderly (n=148) age groups based upon whether they were younger or older than 50 years of age. Of these patients, 247 survivors were included in subsequent analyses over an average 26.8 ± 11.6 month follow-up duration. Multivariate analyses in the elderly group instead of young group indicated that increased BMI (p=0.042), BMI ≤ 18.5 kg/m2 (p=0.025), and lower LBM index values (p=0.019) were significant predictors of increased total all-cause cumulative mortality. BMI was considerably positively correlated with estimated all-cause cumulative mortality in elderly but not young TAAD cases. Conclusion: Briefly, these results suggest that BMI and LBM indices are only significant predictors of TAAD patient all-cause mortality in elderly patient cohorts, whereas they do not offer significant prognostic value for younger patients. As such, these age differences must be taken into consideration when conducting stratified risk assessments based upon TAAD patient body composition characteristics.

scholarly journals Treatment for Acute Type A Aortic Dissection in the Elderly

2003 ◽  
Vol 32 (4) ◽  
pp. 209-214
Author(s):  
Saeki Tsukamoto ◽  
Shoji Shindo ◽  
Masahiro Obana ◽  
Kenji Akiyama ◽  
Motomi Shiono ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Acute Type ◽  
Type A Aortic Dissection

scholarly journals Clinical Outcomes of Limited-repair Strategy and Conservative Approach for the Elderly With Acute Type A Aortic Dissection

2021 ◽  
Author(s):  
Yasumi Maze ◽  
Toshiya Tokui ◽  
Masahiko Murakami ◽  
Bun Nakamura ◽  
Ryosai Inoue ◽  
...  
Keyword(s):  
Survival Rate ◽  
Treatment Group ◽  
Aortic Dissection ◽  
Type A ◽  
The Elderly ◽  
Elderly Group ◽  
Acute Type ◽  
Conservative Approach ◽  
Type A Aortic Dissection ◽  
Hemiarch Replacement

Abstract BackgroundThere is controversy regarding surgical indication and surgical procedure of acute type A aortic dissection for the elderly. We examined surgical outcomes for the elderly.MethodsFrom January 2012 to December 2019, 174 patients underwent surgical repair for acute type A aortic dissection. We compared the surgical outcomes between the elderly group (≧80 years old) and the non-elderly group (≦79 years old). Additionally, we compared the surgical treatment group with the conservative treatment group.ResultsThe primary entry was found in the ascending aorta in 51.6% of the elderly group and in 32.8% of the non-elderly group (p= 0.049). In the elderly group, ascending or hemiarch replacement was performed in all cases, while in the non-elderly group, ascending or hemiarch replacement was performed in 57.3% (p<0.001). The hospital mortality was similar in both groups. The 5-year survival rate was 48.4±10.3% in the elderly group and 86.7±2.9% in the non-elderly group (p<0.001). The rates of freedom from aortic event at 5 years was 86.9±8.7% in the elderly group and 86.5±3.9% in the non-elderly group (p=0.771). The 5-year survival rate of conservative treatment group was 19.2±8.0% in the elderly. There was no significant difference from the surgical treatment group (p=0.103).ConclusionsThe surgical approach may not always be the reasonable treatment of choice for the elderly because the significant survival merit was not achieved compared with the conservative approach.

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