Early and Midterm Outcomes Following Surgery for Acute Type A Aortic Dissection

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Abstract

Objective:

Surgical repair of acute Type A aortic dissection (AADA) is still associated with high in-hospital mortality. We evaluated the impact of perioperative risk factors on early and midterm survival.

Methods:

Retrospective (2002–2011) database analysis at a single institution of 132 consecutive AADA patients (88 male, age 59.8 ± 13.6). All but five patients underwent repair with open distal anastomoses and hypothermic circulatory arrest: aortic valve replacement/root replacement (n = 44, 33.3%) and valve re-suspension/repair (n = 88, 66.7%). Ascending aorta, hemi-arch, and total arch repairs were performed in 11, 113, and eight patients, respectively. Antegrade and retrograde cerebral perfusion were used in all but six patients.

Results:

Overall in-hospital mortality was 17.4% (n = 23). Actuarial survival at one, five, and eight years was 82%, 72%, and 62%, respectively. Perfusion time (cardiopulmonary bypass) (226.5 ± 71.3 vs. 177.5 ± 51.7, p = 0.0002), aortic cross-clamp time (min) (132.8 ± 45.7 vs. 109.8 ± 41.2, p = 0.01), aortic arch (T2) tear (31% vs. 14%, p = 0.03), instability (26% vs. 11%, p = 0.02), postoperative stroke (38% vs. 14%, p = 0.009), and low cardiac output (50% vs. 15%, p = 0.04) all correlated with increased perioperative mortality. A Cox proportional hazard model showed perfusion time (hazard ratio [HR] = 1.01), postoperative stroke (HR = 2.73), age (HR = 1.03), and unstability (HR = 1.8) as significant risk factors (p < 0.05) affecting the overall survival.

Conclusion:

There is a modern trend towards improving overall perioperative outcomes after surgical repair of AADA; however, early mortality and morbidity remain high even in aortic surgery referral centers.

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