Background: Aggressive resection/exclusion of the primary entry in the descending aorta remains controversial in older patients with acute type A aortic dissection (ATAAD). We investigated the effect of residual primary entry in the descending aorta in younger and older groups.
Methods: Patients with ATAAD who underwent emergency surgery (n=1103) were divided into younger (< 70 years; n=681) and older (≥ 70 years; n=422) cohorts. Each cohort was further divided into groups with or without residual primary entry in the descending aorta. After propensity score matching, 179 and 71 matched pairs were obtained in the younger and older cohorts, respectively. Surgical outcomes were compared between the residual and non-residual groups in each age cohort.
Results: In the younger cohort, the cumulative incidence rate of distal aortic events was significantly higher in the residual than in the non-residual group (10-year: 35 [95% CI, 27-44] % vs. 22 [15-31] %, P=.001). However, in the older group, residual or non-residual primary entry did not affect the rates (10-year:11 [5-20] % vs. 9 [4-17] %, P=.75). Multivariate analysis identified age < 70 years (P<.001; HR, 2.188; 95% CI, 1.493, 3.205) and residual primary entry at the descending aorta (P<.001; HR, 2.142; 95% CI, 1.559-2.943) as significant predictors for distal aortic events.
Conclusions: Aggressive resection/exclusion of the primary entry in the descending aorta should be considered for patients aged < 70 years to avoid distal aortic events; however, it might not always be appropriate for the older patients ≥ 70 years.
Keywords: Aortic dissection; distal aortic event; older adult; type A dissection.
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