Open AccessImportance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25‐Year Follow‐Up in 252 Patients
Author(s) -
Melby Spencer J.,
Zierer Andreas,
Damiano Ralph J.,
Moon Marc R.
Publication year - 2013
Publication title -
the journal of clinical hypertension
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.909
H-Index - 67
eISSN - 1751-7176
pISSN - 1524-6175
DOI - 10.1111/jch.12024
Subject(s) - medicine , aortic dissection , blood pressure , surgery , stroke (engine) , marfan syndrome , cardiology , aorta , engineering , mechanical engineering
The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years (1984–2009), 252 patients underwent repair of acute type A dissection. Mean follow‐up for reoperation or death was 6.9±5.9 years. Operative mortality was 16% (41 of 252). Multivariate analysis identified one risk factor for operative death: presentation malperfusion ( P =.003). For operative survivors, 5‐, 10‐, and 20‐year survival was 78%±3%, 59%±4%, and 24%±6%, respectively. Late death occurred earlier in patients with previous stroke ( P =.02) and chronic renal insufficiency ( P =.007). Risk factors for late reoperation included male sex ( P =.006), Marfan syndrome ( P <.001), elevated systolic blood pressure (SBP, P <.001), and absence of β‐blocker therapy ( P <.001). Kaplan‐Meier analysis demonstrated at 10‐year follow‐up that patients who maintained SBP <120 mm Hg had improved freedom from reoperation (92±5%) compared with those with SBP 120 mm Hg to 140 mm Hg (74%±7%) or >140 mm Hg (49%±14%, P <.001). At 10‐year follow‐up, patients on β‐blocker therapy experienced 86%±5% freedom from reoperation compared with only 57%±11% for those without ( P <.001). Operative survival was decreased with preoperative malperfusion. Long‐term survival was dependent on comorbidities but not operative approach. Reoperation was markedly increased in patients not on β‐blocker therapy and decreased with improved SBP control. Strict control of hypertension with β‐blocker therapy is warranted following repair of acute type A dissection.