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Contemporary management and outcomes of acute type A aortic dissection: An analysis of the STS adult cardiac surgery database
Author(s) -
Lee Teng C.,
Kon Zachary,
Cheema Faisal H.,
GrauSepulveda Maria V.,
Englum Brian,
Kim Sunghee,
Chaudhuri Paramita S.,
Thourani Vinod H.,
Ailawadi Gorav,
Hughes G. Chad,
Williams Matthew L.,
Brennan J. Matthew,
Svensson Lars,
Gammie James S.
Publication year - 2018
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.13511
Subject(s) - medicine , aortic dissection , intensive care unit , surgery , cohort , stroke (engine) , anesthesia , aorta , mechanical engineering , engineering
Abstract Purpose Management of acute type A aortic dissection (AAAD) is challenging and operative strategies are varied. We used the STS Adult Cardiac Surgery Database (STS ACSD) to describe contemporary surgical strategies and outcomes for AAAD. Methods Between July 2011 and September 2012, 2982 patients with AAAD underwent operations at 640 centers in North America. Results In this cohort, median age was 60 years old, 66% were male, and 80% had hypertension. The most common arterial cannulation strategies included femoral (36%), axillary (27%), and direct aortic (19%). The median perfusion and cross‐clamp times were 181 and 102 min, respectively. The lowest temperature on bypass showed significant variation. Hypothermic circulatory arrest (HCA) was used in 78% of cases. Among those undergoing HCA, brain protection strategies included antegrade cerebral perfusion (31%), retrograde cerebral perfusion (25%), both (4%), and none (40%). Median HCA plus cerebral perfusion time was 40 min. Major complications included prolonged ventilation (53%), reoperation (19%), renal failure (18%), permanent stroke (11%), and paralysis (3%). Operative mortality was 17%. The median intensive care unit and hospital length of stays were 4.7 and 9.0 days, respectively. Among 640 centers, the median number of cases performed during the study period was three. Resuscitation, unresponsive state, cardiogenic shock, inotrope use, age >70, diabetes, and female sex were found to be independent predictors of mortality. Conclusions These data describe contemporary patient characteristics, operative strategies, and outcomes for AAAD in North America. Mortality and morbidity for AAAD remain high.