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Early and Midterm Outcomes Following Surgery for Acute Type A Aortic Dissection
Author(s) -
Pagni Sebastian,
Ganzel Brian L.,
Trivedi Jaimin R.,
Singh Ramesh,
Mascio Christopher E.,
Austin Erle H.,
Slaughter Mark S.,
Williams Matthew L.
Publication year - 2013
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.12170
Subject(s) - medicine , perioperative , aortic dissection , cardiopulmonary bypass , surgery , ascending aorta , aortic arch , cerebral perfusion pressure , hazard ratio , stroke (engine) , anastomosis , deep hypothermic circulatory arrest , perfusion , cardiology , anesthesia , aorta , mechanical engineering , confidence interval , engineering
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. doi: 10.1111/jocs.12170 (J Card Surg 2013;28:543–549)