title: Preoperative cardiopulmonary resuscitation is the only predictor for operative mortality of type A acute aortic dissection: a recent 8-year experience.
abstract: OBJECTIVE
  Several reports have been published on the surgical outcome for type A acute aortic dissection (AAD) with follow-up extending 10-20 years. However, many factors have markedly changed during this long time interval, influencing the outcome. The aim of this study was to review our recent 8-year experiences and to analyze the impact of complicating factors on outcome.
  
  
  METHODS
  Emergency surgical intervention was carried out in 80 patients in the recent eight years. Average age was 64.2 years, ranging from 19 to 90. We used similar techniques for all patients as follows: deep hypothermic circulatory arrest and antegrade selective cerebral perfusion were employed for cerebral protection. The aortic stump was fixed by gelatin resorcin formalin glue and securing Teflon felt strips. Ascending aorta or hemiarch replacement for primary tear excision was employed as much as possible. We evaluated actuarial survival and re-operation free rates. Independent predictors for operative mortality were also examined.
  
  
  RESULTS
  Overall hospital mortality was 6.3% (five patients). Late death was indicated in 10 patients. Actuarial survival rates at 1, 5, 8 years were 85.5%, 75.9%, and 59.2%, respectively. Five patients required re-operation during follow-up. Re-operation free rate at 1 and 8 years were 98.2% and 85.6%, respectively. Multivariate analysis showed that preoperative cardiopulmonary resuscitation (CPR) was the only significant predictor for operative mortality (p=0.001, odds ratio: 2.7).
  
  
  CONCLUSIONS
  Recent 8-year results of emergency surgical intervention for AAD showed satisfactory early and late mortality. However, it is still very hard to rescue patients requiring preoperative CPR.
authors.affiliation: Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
authors.forename: Mitsumasa
authors.initials: M
authors.lastname: Hata
authors.forename: Motomi
authors.initials: M
authors.lastname: Shiono
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Inoue
authors.forename: Akira
authors.initials: A
authors.lastname: Sezai
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Niino
authors.forename: Michio
authors.initials: M
authors.lastname: Funahashi
authors.forename: Nanao
authors.initials: N
authors.lastname: Negishi
authors.forename: Yukiyasu
authors.initials: Y
authors.lastname: Sezai
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000150:complications / Q000601:surgery*; D001014:Aortic Aneurysm / Q000150:complications / Q000601:surgery*; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods