Preoperative cardiopulmonary resuscitation is the only predictor for operative mortality of type A acute aortic dissection: a recent 8-year experience.
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.
Hata
Mitsumasa
M
Second Department of Surgery, Nihon University School of Medicine, Tokyo, Japan.
Shiono
Motomi
M
Inoue
Tatsuya
T
Sezai
Akira
A
Niino
Tetsuya
T
Funahashi
Michio
M
Negishi
Nanao
N
Sezai
Yukiyasu
Y
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