title: Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients.
abstract: OBJECTIVE
  The purpose of this retrospective study was to assess the risk factors for the early and late outcome of the surgical treatment of acute type A aortic dissection, in terms of mortality and morbidity.
  
  
  RESULTS
  From 1976 to 2003, 487 patients with acute type A aortic dissection treated surgically were enrolled. Twenty-five pre-operative and intra-operative variables were analysed to identify conditions influencing early and late morbidity and early mortality. The in-hospital mortality rate including operative death was 22% (107 patients). Multivariable analysis indicated that pre-existing cardiac disease (RR=3.7, 95% CI=1.8-7.4) and cardiopulmonary resuscitation (RR=6.8, 95% CI=2.3-20.2) were independent predictors of in-hospital death. The causes of in-hospital mortality were low cardiac output in 32 patients (6.6%), major brain damage in 24 patients (5.9%), haemorrhage in 11 patients (2.2%), sepsis in nine patients (1.8%), visceral ischaemia in eight patients (1.6%), multiple organ failure in seven patients (1.4%), rupture of the thoracic aorta in six patients (1.2%), respiratory failure in six patients (1.2%), and four intra-operative deaths. The follow-up was 100% complete. The actuarial survival was 94.9+/-1.2% and 88.1+/-2.6%, at 5 and 10 years, respectively.
  
  
  CONCLUSIONS
  Patients' pre-operative co-morbidities and dissection-related complications significantly affect early and late survival and morbidity after surgical treatment of acute type A aortic dissection.
authors.affiliation: Department of Cardiovascular Surgery, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy. bruno_chiappini@hotmail.com
authors.forename: Bruno
authors.initials: B
authors.lastname: Chiappini
authors.forename: Marc
authors.initials: M
authors.lastname: Schepens
authors.forename: Erwin
authors.initials: E
authors.lastname: Tan
authors.forename: Andrea
authors.initials: A
authors.lastname: Dell' Amore
authors.forename: Wim
authors.initials: W
authors.lastname: Morshuis
authors.forename: Karl
authors.initials: K
authors.lastname: Dossche
authors.forename: Marcello
authors.initials: M
authors.lastname: Bergonzini
authors.forename: Nicola
authors.initials: N
authors.lastname: Camurri
authors.forename: Letizia Bacchi
authors.initials: LB
authors.lastname: Reggiani
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marinelli
authors.forename: Roberto
authors.initials: R
authors.lastname: Di Bartolomeo
mesh_terms: D000208:Acute Disease; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality / Q000601:surgery; D005080:Exercise Test; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome