title: Impact of an aggressive surgical approach on surgical outcome in type A aortic dissection.
abstract: BACKGROUND
  To evaluate the impact of an aggressive surgical approach on early and late outcome in type A aortic dissection.
  
  
  METHODS
  From 1983 to 2001, 240 patients underwent operation for acute (n = 138) and chronic (n = 102) type A aortic dissection. The extent of distal aortic resection included the ascending aorta in 39 (16%) patients, hemiarch (HAR) in 47 (20%), and total arch (TAR) in 154 (64%), including 19 patients who also had their descending aorta replaced (DAR).
  
  
  RESULTS
  The in-hospital mortality did not differ between TAR with or without DAR and other more conservative techniques (12.3% versus 16.3%). Actuarial survival at 10 years including in-hospital mortality was 72.4% +/- 3.3% and freedom from reoperation was 77.2% +/- 3.6% for all patients: neither was influenced by the extent of distal aortic resection or acuity of aortic dissection. Multivariate analysis revealed younger age and failure to resect the intimal tear to be independent determinants for late reoperation. However, in contrast to 22 patients who had more conservative operations, none of the patients with TAR required reoperation on the aortic arch through a sternotomy incision.
  
  
  CONCLUSIONS
  An aggressive surgical approach did not adversely influence early and late survival following type A aortic dissection; it reduced the necessity of late reoperation and facilitated distal aortic reoperation.
authors.affiliation: First Department of Surgery, Hamamatsu University School of Medicine, Japan. tkazui@hama-med.ac.jp
authors.forename: Teruhisa
authors.initials: T
authors.lastname: Kazui
authors.forename: Katsushi
authors.initials: K
authors.lastname: Yamashita
authors.forename: Naoki
authors.initials: N
authors.lastname: Washiyama
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Terada
authors.forename: Abul Hasan Muhammad
authors.initials: AH
authors.lastname: Bashar
authors.forename: Takayasu
authors.initials: T
authors.lastname: Suzuki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Ohkura
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001013:Aorta, Thoracic / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000401:mortality / Q000601:surgery; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D012086:Reoperation / Q000401:mortality; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate