Outcome of acute type A aortic dissection: single-center experience from 1998 to 2007.
BACKGROUND
Acute aortic dissection (AAD) is a serious disease of the aorta with high mortality and morbidity, which requires emergency surgical treatment in order to close the site of the dissection and direct blood flow into the true lumen. Improvements in surgical technique have led to better management of patients with reduced operative mortality, although it still remains high. The aim of this study is to evaluate early and late outcomes of the surgical treatment of acute type A aortic dissection at the hospital of Lecce between 1998 and 2007. We also aim to establish a correlation between these outcomes and pre-operative conditions, surgical procedures and location of the site of the tear.


METHODS
From 1998 to 2007, 100 patients (69 males and 31 females, average age 62.2 +/- 12.3 years, range 22-85 years) underwent surgery for acute AAD at the center. Surgical techniques included replacement of the ascending aorta (Asc Ao) with or without valve replacement (including five patients who underwent the Bentall/De Bono procedure) and replacement of the Asc Ao with or without arch or hemiarch replacement.


RESULTS
In-hospital mortality was 22%, with different results between surgery for replacement of the aorta and for aorta with valve replacement (respectively, 16% and 23%). Different mortality rates were found between the distal surgical treatments, with rates of 20.8% and 18.2% respectively between replacements of the Asc Ao and of Asc Ao with arch/hemiarch, although they were not statistically significant. A different mortality rate that was subject to the patient's preoperative condition has also been found (33.3% of mortality in patients in unstable or high-risk condition vs 13.8% in patients in stable condition). The peak reached 43.5% mortality in patients taken to the operating room while in shock or cardiac tamponade. The location of the site of the tear is another factor that distinguishes mortality rates, which are 17.8% if localized at the proximal ascending aorta and 22.2% in the aortic arch. Assessment of the outcome (10 years after surgery), has shown that four patients died several years later but for reasons unrelated to the surgery.


CONCLUSIONS
The surgery of dissection is still an intervention with a relatively high in-hospital mortality risk, and whose outcome, which has been steady in the last 20 years, can be predicted according to the preoperative condition of the patient. This underlines the need to reduce the time of diagnosis indicating immediate surgical treatment.
Zizza
A
A
Institute of Clinical Physiology, National Council of Research, Lecce, Italy. zizza@ifc.cnr.it
Pano
M
M
Zaccaria
S
S
Villani
M
M
Guido
M
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001011:Aorta / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001021:Aortic Valve / Q000473:pathology / Q000601:surgery*; D013504:Cardiovascular Surgical Procedures / Q000401:mortality / Q000706:statistics & numerical data; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy; D016896:Treatment Outcome; D055815:Young Adult