title: Importance of blood pressure control after repair of acute type a aortic dissection: 25-year follow-up in 252 patients.
abstract: The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years (1984-2009), 252 patients underwent repair of acute type A dissection. Mean follow-up for reoperation or death was 6.9±5.9 years. Operative mortality was 16% (41 of 252). Multivariate analysis identified one risk factor for operative death: presentation malperfusion (P=.003). For operative survivors, 5-, 10-, and 20-year survival was 78%±3%, 59%±4%, and 24%±6%, respectively. Late death occurred earlier in patients with previous stroke (P=.02) and chronic renal insufficiency (P=.007). Risk factors for late reoperation included male sex (P=.006), Marfan syndrome (P<.001), elevated systolic blood pressure (SBP, P<.001), and absence of β-blocker therapy (P<.001). Kaplan-Meier analysis demonstrated at 10-year follow-up that patients who maintained SBP <120 mm Hg had improved freedom from reoperation (92±5%) compared with those with SBP 120 mm Hg to 140 mm Hg (74%±7%) or >140 mm Hg (49%±14%, P<.001). At 10-year follow-up, patients on β-blocker therapy experienced 86%±5% freedom from reoperation compared with only 57%±11% for those without (P<.001). Operative survival was decreased with preoperative malperfusion. Long-term survival was dependent on comorbidities but not operative approach. Reoperation was markedly increased in patients not on β-blocker therapy and decreased with improved SBP control. Strict control of hypertension with β-blocker therapy is warranted following repair of acute type A dissection.
authors.affiliation: Division of Cardiothoracic Surgery at the University of Alabama at Birmingham, Birmingham, AL 35294, USA. melbys@uab.edu
authors.forename: Spencer J
authors.initials: SJ
authors.lastname: Melby
authors.forename: Andreas
authors.initials: A
authors.lastname: Zierer
authors.forename: Ralph J
authors.initials: RJ
authors.lastname: Damiano
authors.forename: Marc R
authors.initials: MR
authors.lastname: Moon
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D015897:Comorbidity; D005500:Follow-Up Studies; D006801:Humans; D006973:Hypertension / Q000188:drug therapy* / Q000209:etiology*; D007407:Interviews as Topic; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate
chemical_list: D000319:Adrenergic beta-Antagonists