Clinical Characteristics of Young Patients with Stanford Type A Aortic Dissection_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YAN Chenglei , GAO Changqing , XIAO Cangsong

Department of Cardiovascular Surgery, General Hospital of PLA, Beijing 100853, P. R. China;

Corresponding author：

Keywords：

Aortic dissection; Surgery treatment; Age

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Abstract： Objective To summarize the clinical characteristics of young patients with Stanford type A aortic dissection. Methods We retrospectively analyzed 54 patients with Stanford type A aortic dissection who received surgical treatment in General Hospital of PLA between March 2004 and June 2011. All the patients were divided into two groups: a young patient group with patients’ age less than 40 years and a control group with patients’
age more than or equal to 40 years. There were 23 patients including 17 males and 6 females with an average age of 34.2±6.3 years in the young patient group and 31 patients including 27 males and 4 females with an average age of 51.5±6.8 years in the control group. The clinical characteristics and surgical treatment outcomes of the two groups were compared. Results There was no statistical difference in cardiopulmonary bypass（CBP）time（224.4±83.1 min vs. 215.0±88.0 min, t=0.39, P=0.69） and aortic cross-clamping time（152.3±60.8 min vs. 130.9±51.2 min, t=1.34, P=0.18）between the two groups. Compared with the patients in the control group, young patients were more likely to have congenital malformations with rate at 34.7%（8/23） vs. 6.4%（2/31） with χ2=5.27, P=0.02, such as Marfan syndrome and bicuspid aortic valve. The mortality of the young patients was similar to patients in the control group at rate of 13.0%（3/23）vs.12.9%（4/31） with χ2=0.15 and P=0.69, but postoperative mental and neurological complications rate in the young patient group were less frequent than those in the control group at 4.3%（1/23）vs. 32.2%（10/31） with χ2=5.32 and P=0.02. Conclusion Young patients with Stanford type A aortic dissection have fewer cardiovascular risk factors for aortic dissection but are more likely to have congenital malformations. The surgical methods are more active for young patients with less frequency of postoperative mental and neurological complications.

Citation： YAN Chenglei,GAO Changqing,XIAO Cangsong,et al .. Clinical Characteristics of Young Patients with Stanford Type A Aortic Dissection. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2012, 19(3): 251-253. doi: Copy

1.	Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection. Circulation, 2006, 114 （21）： 2226-2231.
2.	Trimarchi S, Eagle KA, , Nienaber CA, et al. Role of age in acute type A aortic dissection outcome： report from the International Registry of Acute Aortic Dissection （IRAD）. J Thorac Cardiovasc Surg, 2010, 140 （4）： 784-789.
3.	Weigang E, Nienaber CA, Rehders TC, et al. Management of patients with aortic dissection. Dtsch Arztebl Int, 2008, 105 （38）： 639-645.
4.	Chiappini B, Tan ME, Morshuis W, et al. Surgery for acute type A aortic dissection： is advanced age a contraindication? Ann Thorac Surg, 2004, 78 （2）： 585-590.
5.	Ward C. Clinical significance of the bicuspid aortic valve. Heart, 2000, 83 （1）： 81-85.
6.	von Kodolitsch Y, Aydin MA, Koschyk DH, et al. Predictors of aneurysmal formation after surgical correction of aortic coarctation. J Am Coll Cardiol, 2002, 39 （4）： 617-624.
7.	Sakaguchi M, Kitahara H, Seto T, et al. Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome. Eur J Cardiothorac Surg, 2005, 28 （2）： 280-283.
8.	Suehiro K, Pritzwald-Stegmann P, West T, et al. Surgery for acute type a aortic dissection：a 37-year experience in Green Lane Hospital. Heart Lung Circ, 2006, 15 （2）： 105-112.
9.	Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection： results from the International Registry of Aortic Dissection （IRAD） . J Am Coll Cardiol, 2004, 43 （4）： 665-669.
10.	Ehrlich MP, Ergin MA, Mccullough JN, et al. Results of immediate surgical treatment of all acute type A dissections. Circulation, 2000, 102 （19 Suppl 3）： III248-252.
11.	Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection： The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg, 2005, 129 （1）： 112-122.
12.	Narayan P, Rogers CA, Davies I, et al. Type A aortic dissection： has surgical outcome improved with time? J Thorac Cardiovasc Surg, 2008, 136 （5）： 1172-1177.
13.	Mehta RH, O’gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly： clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol, 2002, 40 （4）： 685-692.
14.	Stefano P, Gagliardotto PV, Pompei E, et al. Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 1998, 66 （3）： 779-784.
15.	Okita Y, Kenji M, Osamu T, et al. Prospective comparative study of brain protection in total aortic arch replacement： deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72 （1）： 72-79.
16.	修宗谊, 谷天祥, 阎德民, 等. DeBakeyⅠ型主动脉夹层外科治疗28例．中国胸心血管外科临床杂志, 2007 （05）：389-391．.
17.	肖正华, 张尔永, 郭应强, 等. 腋动脉侧接人工血管插管法在深低温停循环手术中的应用. 中国胸心血管外科临床杂志, 2010, 17 （1）：60-61．.
18.	肖苍松, 高长青, 吴扬, 等. DeBakey I型急性主动脉夹层围术期处理策略. 解放军医学杂志, 2009, 34 （11）：1374-1375, 1384．.
19.	蒋雄刚, 孙图成, 张凯伦, 等. Stanford A型主动脉夹层的外科治疗. 华中科技大学学报：医学版, 2008 （3）：406-408．.

1. 　Tsai TT, Fattori R, Trimarchi S, et al. Long-term survival in patients presenting with type B acute aortic dissection： insights from the International Registry of Acute Aortic Dissection. Circulation, 2006, 114 （21）： 2226-2231.
2. 　Trimarchi S, Eagle KA, , Nienaber CA, et al. Role of age in acute type A aortic dissection outcome： report from the International Registry of Acute Aortic Dissection （IRAD）. J Thorac Cardiovasc Surg, 2010, 140 （4）： 784-789.
3. 　Weigang E, Nienaber CA, Rehders TC, et al. Management of patients with aortic dissection. Dtsch Arztebl Int, 2008, 105 （38）： 639-645.
4. 　Chiappini B, Tan ME, Morshuis W, et al. Surgery for acute type A aortic dissection： is advanced age a contraindication? Ann Thorac Surg, 2004, 78 （2）： 585-590.
5. 　Ward C. Clinical significance of the bicuspid aortic valve. Heart, 2000, 83 （1）： 81-85.
6. 　von Kodolitsch Y, Aydin MA, Koschyk DH, et al. Predictors of aneurysmal formation after surgical correction of aortic coarctation. J Am Coll Cardiol, 2002, 39 （4）： 617-624.
7. 　Sakaguchi M, Kitahara H, Seto T, et al. Surgery for acute type A aortic dissection in pregnant patients with Marfan syndrome. Eur J Cardiothorac Surg, 2005, 28 （2）： 280-283.
8. 　Suehiro K, Pritzwald-Stegmann P, West T, et al. Surgery for acute type a aortic dissection：a 37-year experience in Green Lane Hospital. Heart Lung Circ, 2006, 15 （2）： 105-112.
9. 　Januzzi JL, Isselbacher EM, Fattori R, et al. Characterizing the young patient with aortic dissection： results from the International Registry of Aortic Dissection （IRAD） . J Am Coll Cardiol, 2004, 43 （4）： 665-669.
10. 　Ehrlich MP, Ergin MA, Mccullough JN, et al. Results of immediate surgical treatment of all acute type A dissections. Circulation, 2000, 102 （19 Suppl 3）： III248-252.
11. 　Trimarchi S, Nienaber CA, Rampoldi V, et al. Contemporary results of surgery in acute type A aortic dissection： The International Registry of Acute Aortic Dissection experience. J Thorac Cardiovasc Surg, 2005, 129 （1）： 112-122.
12. 　Narayan P, Rogers CA, Davies I, et al. Type A aortic dissection： has surgical outcome improved with time? J Thorac Cardiovasc Surg, 2008, 136 （5）： 1172-1177.
13. 　Mehta RH, O’gara PT, Bossone E, et al. Acute type A aortic dissection in the elderly： clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol, 2002, 40 （4）： 685-692.
14. 　Stefano P, Gagliardotto PV, Pompei E, et al. Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg, 1998, 66 （3）： 779-784.
15. 　Okita Y, Kenji M, Osamu T, et al. Prospective comparative study of brain protection in total aortic arch replacement： deep hypothermic circulatory arrest with retrograde cerebral perfusion or selective antegrade cerebral perfusion. Ann Thorac Surg, 2001, 72 （1）： 72-79.
16. 　修宗谊, 谷天祥, 阎德民, 等. DeBakeyⅠ型主动脉夹层外科治疗28例．中国胸心血管外科临床杂志, 2007 （05）：389-391．.
17. 　肖正华, 张尔永, 郭应强, 等. 腋动脉侧接人工血管插管法在深低温停循环手术中的应用. 中国胸心血管外科临床杂志, 2010, 17 （1）：60-61．.
18. 　肖苍松, 高长青, 吴扬, 等. DeBakey I型急性主动脉夹层围术期处理策略. 解放军医学杂志, 2009, 34 （11）：1374-1375, 1384．.
19. 　蒋雄刚, 孙图成, 张凯伦, 等. Stanford A型主动脉夹层的外科治疗. 华中科技大学学报：医学版, 2008 （3）：406-408．.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Clinical Characteristics of Young Patients with Stanford Type A Aortic Dissection

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