title: Acute type A aortic dissection: 18 years of experience in one center (Hospital 12 de Octubre).
abstract: Here, we review our experience in acute type A aortic dissection analyzing the role of antegrade brain protection. A total of 105 patients underwent surgery for acute type A aortic dissection between March 1990 and October 2008. An open technique with deep hypothermia was used in 81 patients. Deep hypothermia alone was induced in 32 patients; in combination with retrograde cerebral perfusion in 26 patients and in combination with antegrade cerebral perfusion (ACP) in the final 23 patients. The overall hospital mortality rate was 15%. Hospital mortality risk factors were age >or=70 years and preoperative shock (P<0.05). Hospital mortality was reduced to 9% in the last 23 consecutive patients in whom ACP was accomplished (P=0.05). Survival rate after 1, 5, 10 and 15 years of follow-up was 97.6+/-1.7%, 84.3+/-4.4%, 60.7+/-7.5% and 57.1+/-7.8%, respectively. The only late death risk predictor was the non-use of ACP (P<0.05). Surgery for acute aortic dissection provides excellent results. ACP via the axillary artery improves the prognosis for these patients and should be the brain protection method of choice.
authors.affiliation: Department of Cardiac Surgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Forteza
authors.forename: Carlos
authors.initials: C
authors.lastname: Martín
authors.forename: Jorge
authors.initials: J
authors.lastname: Centeno
authors.forename: María Jesús
authors.initials: MJ
authors.lastname: López
authors.forename: Enrique
authors.initials: E
authors.lastname: Pérez
authors.forename: Javier
authors.initials: J
authors.lastname: de Diego
authors.forename: Violeta
authors.initials: V
authors.lastname: Sánchez
authors.forename: José
authors.initials: J
authors.lastname: Cortina
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001366:Axillary Artery / Q000503:physiopathology; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control*; D050792:Circulatory Arrest, Deep Hypothermia Induced; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods*; D016016:Proportional Hazards Models; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000401:mortality