The outcome of surgical management of type A aortic dissection

Abstract

Background Type A aortic dissection is a serious and fatal condition. Methods We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5 ± 13.8 years, who were treated between 2006 and 2011. Most patients were male (70, 65%). Results Circulatory arrest with a mean duration of 22 ± 16 min was performed in 42 (38.9%) patients. Perioperative mortality was 15.7% ( n = 17). Univariate analysis showed that cardiopulmonary bypass time ( p = 0.0006), age >60 years ( p = 0.028), cardiogenic shock at presentation ( p = 0.02), New York Heart Association class II–IV ( p = 0.038), hemopericardium ( p = 0.0035), and preoperative cerebrovascular accident ( p = 0.02) were predictors of mortality. Multivariate analysis indicated that age >60 years (odds ratio 7.7, 95% confidence interval: 1.52–38.96, p = 0.0136), preoperative cerebrovascular accident (odds ratio 25.2, 95% confidence interval: 2.45–258.9, p = 0.0066), hemopericardium (odds ratio 41.6, 95% confidence interval: 5.38–320.7, p = 0.0003), and cardiopulmonary bypass time (odds ratio 1.85, 95% confidence interval: 1.32–2.57, p = 0.0003) were independent predictors of perioperative mortality. The 1- and 4-year survival was 80% ± 3.8% and 69% ± 5.7%, respectively. Age >60 years (hazard ratio 3.3, 95% confidence interval: 1.4–7.9, p = 0.0064) was the only independent predictor of long-term mortality. Conclusion Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.