Association of Stanford, DeBakey classification and false-lumen blood flow with age of onset in acute aortic dissection

Background Younger patients with acute aortic dissection (AAD) are thought to present with distinct anatomical and hemodynamic features compared with older patients. This study evaluated the association between age, dissection extent, and false-lumen flow characteristics in AAD. Methods and results We retrospectively analyzed 400 consecutive patients with radiologically confirmed AAD from April 2014 to April 2024, categorizing them into a younger group (76 years, n = 229) and an older group (≥76 years, n = 171). The distribution of Stanford type A vs. B dissections was similar between groups. However, younger patients more frequently demonstrated DeBakey type I dissection, whereas older patients more commonly had type II. Regarding false-lumen morphology, younger patients showed a higher prevalence of communicating false lumen, while non-communicating patterns predominated in the elderly. Although overall sex distribution of false-lumen types was not significantly different, younger males were more prevalent within each subtype. Preoperative malperfusion occurred more often in younger patients, whereas 30-day mortality did not differ significantly between age groups. Conclusions Younger AAD patients typically exhibit more extensive dissection and patent false-lumen flow, while older patients more often present with localized dissection and thrombosed false lumen. These age-related distinctions may reflect progressive aortic wall stiffening and should be considered in clinical assessment and management strategies.