The Correlation of Age and Extension Length in Debakey Type I Aortic Dissection: Are Septuagenarians at a Lower Risk?

Introduction: Elderly patients have been suggested to be more prone to acute aortic dissection due to a higher incidence of age-related atherosclerosis and stiffness of the thoracic aorta. Hypothesis: Younger patients suffer more extensive DeBakey type I dissections due to aortic wall integrity, potentially allowing unhindered extension. The study's aim was to correlate age and dissection extension length in a large contemporary multi-center cohort. Methods: The perioperative data of 3385 patients with acute aortic dissection were retrospectively analyzed with regard to postoperative outcome and dissection extent. DeBakey type I aortic dissections (n=2510) were identified and divided into two groups: <70 years (n=1741) and >70 years (n=769). Patients with DeBakey type II and connective tissue disease were excluded (n=875). Results: Septuagenarians (>70 yrs) had a higher incidence of atherosclerosis (32.0% vs. 18.9%; p<0.001) and showed significantly more often a limitation of dissection extension until the aortic arch level (40.9% vs. 29.2%; p<0.001). In younger patients, aortic dissections involved the supraaortic vessels more often (52.0% vs. 40.1%; p<0.001) and extended significantly further downstream the aorta: descending aorta (68.5% vs. 57.1%; p<0.001), abdominal aorta (54.7% vs. 42.0%; p<0.001) and iliac bifurcation (36.6% vs. 26.0%; p<0.001) ( Fig.1 ). Clinically, younger patients presented with significantly higher incidences of preoperative cerebral (p=0.002), spinal (p=0.003), visceral (p=0.002) and peripheral (p<0.001) malperfusion. In-hospital mortality rates in patients <70 yrs and >70 yrs were 18.9% and 22.2% (p=0.067), respectively. Conclusions: Extensive DeBakey type I aortic dissection is less frequent in septuagenarians. Conversely, younger patients suffer significantly more often from preoperative organ malperfusion and associated complications. Postoperative mortality remains high irrespective of age groups.