Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients.
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.
Chiappini
Bruno
B
Department of Cardiovascular Surgery, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy. bruno_chiappini@hotmail.com
Schepens
Marc
M
Tan
Erwin
E
Dell' Amore
Andrea
A
Morshuis
Wim
W
Dossche
Karl
K
Bergonzini
Marcello
M
Camurri
Nicola
N
Reggiani
Letizia Bacchi
LB
Marinelli
Giuseppe
G
Di Bartolomeo
Roberto
R
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