Surgical Treatment of Acute Type A Aortic Dissection: In-Hospital Outcomes and Long-Term Follow-Up

pp. 108-115

Abstract

Background

Acute type A aortic dissection (AAD-A) is an extremely severe condition that requires emergency surgery. In spite of advances in surgical techniques, the procedure still carries great morbidity and mortality rates.

Objectives

To analyze in-hospital morbidity and mortality and longterm survival of a consecutive series of patients undergoing surgery for AAD-A.

Material and Methods

We included 63 consecutive patients (71% were men) in four health care centers in Buenos Aires from July 1994 to May 2007. Eighty nine percent of patients completed follow-up. Mean age was 63±11.3 years. Aortic hemiarch was replaced in 15 patients and 5 patients received complete aortic replacement. Aortic valve replacement was performed in 12 patients.

Results

During hospitalization 19 patients (30.1%) died: one death occurred at the operation room, 7 patients died due to ischemic complications or multi organ failure, 3 patients died of neurological complications, 5 of cardiac complications, 1 of gastrointestinal bleeding and 2 deaths were a consequence of multiple complications. Twelve patients (32.4%) died during follow-up (8 cardiac deaths and 4 non cardiac deaths). Multivariate analysis detected that low cardiac output and cardiac bypass pump (CBP) duration were associated with greater in-hospital mortality rates, while age >70 years and lower CBP duration correlated with greater long-term mortality. Survival rates at 1, 3, 5 and 10 years were 89%, 79,5%, 73% and 58%, respectively.

Conclusions

Surgical results of AAD-A in our environment are similar to those published in international series, confirming high in-hospital and long-term morbidity and mortality rates associated with this condition.