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

• DOI: 10.1111/jocs.12170
• Publication Date: 2013-08-02T12:07:38Z
• Authors: Sebastian Pagni; Brian L. Ganzel; Jaimin R. Trivedi; Ramesh Singh; Christopher E. Ma...; Erle H. Austin; Mark S. Slaughter; Matthew L. Williams
• Keywords: Heart Valve Prosthesis Implantation; Male; Time Factors; Kentucky; Aorta, Thoracic; Middle Aged; Aortic Aneurysm; 3. Good health; Hospitals, University; Perfusion; Survival Rate; Aortic Dissection; Blood Vessel Prosthesis Implantation; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Risk Factors; Aortic Valve; Humans; Hospital Mortality; Aorta; Aged; Retrospective Studies

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.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.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.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.