title: Type A aortic dissection: has surgical outcome improved with time?
abstract: OBJECTIVE
  The study objective was to determine whether developments in surgical, anesthetic, and perfusion techniques in the treatment of type A aortic dissection have resulted in improved clinical outcome.
  
  
  METHODS
  A consecutive series of 165 patients undergoing surgical repair of type A aortic dissection performed between April of 1992 and March of 2006 in a single center were analyzed. Operations were grouped in 2 time frames of equal length (before April of 1999 vs from April of 1999 onward).
  
  
  RESULTS
  There were 30 in-hospital deaths (18.2%), and the death rate was similar in the 2 time periods. Patients who underwent operation in the recent era compared with the earlier era were older (median 62 years [interquartile range 51-68] vs 59 years [45-68], P = .18), with a significantly higher incidence of concomitant coronary artery disease (13 [18%] vs 5 [7%], P = .03]) and significantly worse (moderate to poor) left ventricular function (33 [40%] vs 13 [18%], P = .002). The duration of circulatory arrest was shorter in the recent era (median 31 minutes [interquartile range 26.5-39] vs 37.5 minutes [31-45], P = .009), with a higher incidence of concomitant procedures (19 [21%] vs 10 [14%], P = .22). Except for total hospital stay, which increased over time, there were no significant differences in postoperative outcome.
  
  
  CONCLUSIONS
  Despite the adoption of techniques to improve outcome for patients with type A dissection, mortality remains unchanged. A deteriorating risk profile and factors relating to the disease process itself may explain this observation.
authors.affiliation: Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom.
authors.forename: Pradeep
authors.initials: P
authors.lastname: Narayan
authors.forename: Chris A
authors.initials: CA
authors.lastname: Rogers
authors.forename: Ian
authors.initials: I
authors.lastname: Davies
authors.forename: Gianni D
authors.initials: GD
authors.lastname: Angelini
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Bryan
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000379:methods; D003327:Coronary Disease / Q000150:complications; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology