title: Contemporary results following surgical repair of acute type a aortic dissection (AAAD): a single centre experience.
abstract: OBJECTIVE
  The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).
  
  
  METHODS
  Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.
  
  
  RESULTS
  The mean age was 61years; 60% were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45%, malperfusion syndrome in 59%, moderate-severe aortic regurgitation in 48% and tamponade in 16%. EF was <40% in 17%. There was a delay of >12hours between diagnosis and operation in 64%. Axillary cannulation was performed in 37%. Cerebral protection was by hypothermic arrest (HCA) alone (19%), HCA with retrograde cerebral perfusion (RCP) (11%), or HCA with antegrade cerebral perfusion (ACP) (46%). The procedure was performed on cross-clamp in 24%. Full arch replacement was performed in 14% and concomitant coronary artery grafting was performed in 11%. Post-operative neurological dysfunction was present in 33.8%. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53%. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70% at two years, 50% at five years and 25% at nine years. Functional outcomes and long-term quality of life were assessed in 69% of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.
  
  
  CONCLUSIONS
  Discharged patients have reasonable long-term survival and good quality of life.
authors.affiliation: Department of Cardiac Surgery, Princess Alexandra Hospital, Woolloongabba, Brisbane, QLD 4120, Australia.
authors.forename: Andrew J M
authors.initials: AJ
authors.lastname: Campbell-Lloyd
authors.forename: Julie
authors.initials: J
authors.lastname: Mundy
authors.forename: Nigel
authors.initials: N
authors.lastname: Pinto
authors.forename: Annabelle
authors.initials: A
authors.lastname: Wood
authors.forename: Elaine
authors.initials: E
authors.lastname: Beller
authors.forename: Stephen
authors.initials: S
authors.lastname: Strahan
authors.forename: Pallav
authors.initials: P
authors.lastname: Shah
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002305:Cardiac Tamponade; D050792:Circulatory Arrest, Deep Hypothermia Induced / Q000379:methods; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000209:etiology; D011379:Prognosis; D011788:Quality of Life; D051437:Renal Insufficiency / Q000209:etiology; D012189:Retrospective Studies; D013318:Stroke Volume; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods*; D055815:Young Adult