title: Changing surgical management for acute aortic dissections type a improves immediate outcomes.
abstract: BACKGROUND
  Surgical treatment of acute aortic dissection type A is well established. This study analyzes the impact of changing surgical management of Type A dissections on hospital mortality and postoperative complications.
  
  
  METHODS
  Between January 1980 and December 2002, 141 consecutive patients were operated for acute Type A aortic dissection. Patients were analyzed in 3 time periods; 1980-1989, n = 26, 1990-1999, n = 71 and 2000-2002, n = 44). Antegrade cerebral perfusion via subclavian cannulation, a more extensive resection as well as valvar repair was introduced as routine procedures from January 2000.
  
  
  RESULTS
  Mortality and neurological complications decreased over time; from 31% to 9.1% and from 27% to 2.5%, respectively. During follow-up, 14 patients (12%) required surgical re-intervention for aneurysms (1 to 17 years later) with associated hospital mortality of 21%.
  
  
  CONCLUSIONS
  Antegrade cerebral perfusion reduces neurological complications and more extensive surgical approach did not increase mortality and morbidity.
authors.affiliation: Department of Cardiovascular Surgery, University Hospital of Geneva, Geneva, Switzerland.
authors.forename: Jorge
authors.initials: J
authors.lastname: Sierra
authors.forename: Jan T
authors.initials: JT
authors.lastname: Christenson
authors.forename: Afksendiyos
authors.initials: A
authors.lastname: Kalangos
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D002545:Brain Ischemia / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000379:methods; D002560:Cerebrovascular Circulation / Q000502:physiology; D015331:Cohort Studies; D003422:Critical Care / Q000379:methods; D016638:Critical Illness / Q000401:mortality; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D018709:Statistics, Nonparametric; D016019:Survival Analysis