Surgery for acute type a aortic dissection a 37-year experience in Green Lane Hospital

• Published in: Heart, lung & circulation Vol. 15; no. 2; pp. 105 - 112
• Main Authors: Suehiro, Kotaro, Pritzwald-Stegmann, Patrick, West, Teena, Kerr, Alan R, Haydock, David A
• Format: Journal Article
• Language: English
• Published: Australia 01-04-2006
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; Cardiac Surgical Procedures - mortality; Cardiac Surgical Procedures - standards; Cardiac Surgical Procedures - utilization; Female; Hospital Mortality; Humans; Longitudinal Studies; Male; Medical Audit; Middle Aged; New Zealand - epidemiology; Outcome Assessment (Health Care); Proportional Hazards Models; Reoperation - utilization; Risk Assessment; Risk Factors; Survival Analysis; New Zealand
• ISSN: 1443-9506
• DOI: 10.1016/j.hlc.2006.01.003

To review the management of patients with acute type A aortic dissection.
Between June 1967 and December 2003, 246 patients (151 males and 95 females, 20-82 years; median 59 years) underwent operation for type A dissection. Early mortality and aortic dissection-related late events (reoperation and death related to aortic dissection) were assessed and correlated with the surgical approach.
Over 37 years, early mortality has markedly improved, 50% in 1970s, 22% in 1980s, 17% in 1990s, and 11% after 2000. However, late deaths occurred at a constant rate, overall late survival at 10 and 20 years were 59% and 9%, respectively, and this did not improve after the 1990s. Preoperative hemodynamic instability, myocardial and kidney malperfusion, smoking history, prolonged bypass and cross-clamp time, and year of surgery were found to be risk factors for early death. The main cause (21%) of late deaths was aortic dissection-related events, especially in the distal aorta. However, no intraoperative risk factors were found to be predictive of late dissection-related events. Surgical techniques including complete resection of the intimal tear or distal extent of the surgery had no impact on late distal event-free survival.
Despite improvement of short-term outcome over 37 years, patients who had aortic dissection are still living with elevated risk of death. Although late events in the distal aorta were a major risk, aggressive surgical approaches did not improve these outcomes. Vigilant follow-up is necessary for these patients.