title: Clinical outcome of emergency surgery for complicated acute type B aortic dissection.
abstract: BACKGROUND
  The aim of the present study was to review the clinical profile and outcome of emergency surgery for complicated acute type B aortic dissection.
  
  
  RESULTS
  A total of 34 consecutive patients requiring surgical treatment for complicated acute type B aortic dissection between 2003 and 2010 were examined. The median age was 64.0 years (range, 19-82 years). Indication for emergency surgery was aortic rupture in 11 patients, rapid expansion of the dissecting aorta in 5, dissection involving a non-dissecting aneurysm in 6, and organ malperfusion in 12. All of 3 patients with open aortic rupture died during surgery. Operative mortality was 9.7% (central operation, 14.2%; peripheral operation, 7.1%; thoracic endovascular aneurysm repair, 0%). There were 2 aortic ruptures within 1 week after operation. Two patients suffered from persistent organ malperfusion after emergency surgical relief of ischemia and died. The 1- and 5-year survival rates were 74.1 ± 8.1% and 64.8 ± 11.2%. The actual rate of freedom from aortic events at 1- and 5- years was 83.0 ± 7.0% and 58.7 ± 11.4%.
  
  
  CONCLUSIONS
  Emergency surgery for complicated acute type B dissection still has a high mortality rate for patients with open rupture and critical visceral ischemia. Medical treatment is best given immediately after admission, and adequate surgical treatment without delay is crucial.
authors.affiliation: Department of Cardiovascular Surgery, Kobe City Medical Center General Hospital, Kobe, Japan. tmurashita@kcho.jp
authors.forename: Takashi
authors.initials: T
authors.lastname: Murashita
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Ogino
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Matsuda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Sasaki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Tanaka
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Iba
authors.forename: Keitaro
authors.initials: K
authors.lastname: Domae
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Fujiwara
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult