title: Surgical treatment of acute type A dissection: is rupture a risk factor?
abstract: BACKGROUND
  The purpose of this study was to evaluate the significance of aortic rupture on clinical outcome in patients after aortic repair for acute type A dissection.
  
  
  METHODS
  One hundred and twenty patients underwent aortic operations with resection of the intimal tear and open distal anastomosis. Median age was 60 years (range 16 to 87); 78 were male. Thirty-six patients had only ascending aortic replacement, 82 had hemiarch repair, and 2 had the entire arch replaced. Retrograde cerebral perfusion was utilized in 66 patients (53%). Rupture defined as free blood in the pericardial space was present in 60 patients (50%). Univariate and multivariate analyses were performed to assess the risk factors for mortality and neurologic dysfunction.
  
  
  RESULTS
  Overall hospital mortality rate was 24.2% +/- 4.0% (+/- 70% confidence level) but did not differ between patients with aortic rupture or without (p = 0.83). The incidence of permanent neurologic dysfunction was 9.4% overall, 10.5% with rupture and 8.3% without rupture (p = 0.75). Multivariate analysis revealed absence of retrograde cerebral perfusion and any postoperative complication as statistically significant indicators for in-hospital mortality (p < 0.05). Overall 1- and 5-year survival was 85.3% and 33.7%; among discharged patients, survival in the nonruptured group was 89% and 37%, versus 81% and 31% in the ruptured group (p = 0.01).
  
  
  CONCLUSIONS
  Aortic rupture at the time of surgery does not increase the risk of hospital mortality or permanent neurologic complications in patients with acute type A dissections. However, aortic rupture at the time of surgery does influence long-term survival.
authors.affiliation: Department of Cardiothoracic Surgery, University of Vienna, Austria. marekehrlich@hotmail.com
authors.forename: Marek P
authors.initials: MP
authors.lastname: Ehrlich
authors.forename: Martin
authors.initials: M
authors.lastname: Grabenwöger
authors.forename: Juliane
authors.initials: J
authors.lastname: Kilo
authors.forename: Alfred A
authors.initials: AA
authors.lastname: Kocher
authors.forename: Georg
authors.initials: G
authors.lastname: Grubhofer
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Lassnig
authors.forename: Edda M
authors.initials: EM
authors.lastname: Tschernko
authors.forename: Bernhard
authors.initials: B
authors.lastname: Schlechta
authors.forename: Doris
authors.initials: D
authors.lastname: Hutschala
authors.forename: Hans
authors.initials: H
authors.lastname: Domanovits
authors.forename: Gottfried
authors.initials: G
authors.lastname: Sodeck
authors.forename: Ernst
authors.initials: E
authors.lastname: Wolner
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D001019:Aortic Rupture / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate