Surgical outcome of acute type A aortic dissection: analysis of risk factors.
BACKGROUND
The aim of this study was to assess the risk factors for the early and late outcome of the surgical treatment of acute type A aortic dissection.


METHODS
From 1983 to 2000, a total of 130 patients underwent operation for acute type A aortic dissection. Extent of distal aortic resection included ascending aorta in 19 patients (15%), hemiarch in 29 (22%), and total arch in 82 (63%). In all, 31 preoperative and perioperative variables were analyzed using univariate and multiple logistic regression models for independent predictors of in-hospital mortality and risk of late reoperation. After excluding in-hospital deaths, risk factors for late death were analyzed by Cox proportional hazard analysis.


RESULTS
In-hospital mortality was 19.2% (25 of 130 patients). Multivariable analysis indicated that renal/mesenteric ischemia and shock were independent predictors of in-hospital death. At 10 years, the actuarial survival rate including in-hospital mortality was 70.9% +/- 4.7%, and the reoperation event-free rate was 73.5% +/- 5.7%. Aortic valve resuspension was an independent predictor of proximal aortic reoperation, whereas nonresection of intimal tear and younger age were independent predictors for distal aortic reoperation. Chronic obstructive pulmonary disease was the only independent predictor for late death.


CONCLUSIONS
Patients' preoperative dissection-related complications and comorbidities significantly affect early and late survival rates after surgical treatment of acute type A aortic dissection.
Kazui
Teruhisa
T
First Department of Surgery, Hamamatsu University School of Medicine, Japan. tkazui@hama-med.ac.jp
Washiyama
Naoki
N
Bashar
Abul Hasan Muhammad
AH
Terada
Hitoshi
H
Suzuki
Takayasu
T
Ohkura
Kazuhiro
K
Yamashita
Katsushi
K
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome