title: Early and midterm outcomes following surgery for acute type A aortic dissection.
abstract: OBJECTIVE
  Surgical repair of acute Type A aortic dissection (AADA) is still associated with high in-hospital mortality. We evaluated the impact of perioperative risk factors on early and midterm survival.
  
  
  METHODS
  Retrospective (2002-2011) database analysis at a single institution of 132 consecutive AADA patients (88 male, age 59.8 ± 13.6). All but five patients underwent repair with open distal anastomoses and hypothermic circulatory arrest: aortic valve replacement/root replacement (n=44, 33.3%) and valve re-suspension/repair (n=88, 66.7%). Ascending aorta, hemi-arch, and total arch repairs were performed in 11, 113, and eight patients, respectively. Antegrade and retrograde cerebral perfusion were used in all but six patients.
  
  
  RESULTS
  Overall in-hospital mortality was 17.4% (n=23). Actuarial survival at one, five, and eight years was 82%, 72%, and 62%, respectively. Perfusion time (cardiopulmonary bypass) (226.5 ± 71.3 vs. 177.5 ± 51.7, p=0.0002), aortic cross-clamp time (min) (132.8 ± 45.7 vs. 109.8 ± 41.2, p=0.01), aortic arch (T2) tear (31% vs. 14%, p=0.03), instability (26% vs. 11%, p=0.02), postoperative stroke (38% vs. 14%, p=0.009), and low cardiac output (50% vs. 15%, p=0.04) all correlated with increased perioperative mortality. A Cox proportional hazard model showed perfusion time (hazard ratio [HR]=1.01), postoperative stroke (HR=2.73), age (HR=1.03), and unstability (HR=1.8) as significant risk factors (p<0.05) affecting the overall survival.
  
  
  CONCLUSIONS
  There is a modern trend towards improving overall perioperative outcomes after surgical repair of AADA; however, early mortality and morbidity remain high even in aortic surgery referral centers.
authors.affiliation: Division of Thoracic and Cardiovascular Surgery, University of Louisville, Louisville, Kentucky.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pagni
authors.forename: Brian L
authors.initials: BL
authors.lastname: Ganzel
authors.forename: Jaimin R
authors.initials: JR
authors.lastname: Trivedi
authors.forename: Ramesh
authors.initials: R
authors.lastname: Singh
authors.forename: Christopher E
authors.initials: CE
authors.lastname: Mascio
authors.forename: Erle H
authors.initials: EH
authors.lastname: Austin
authors.forename: Mark S
authors.initials: MS
authors.lastname: Slaughter
authors.forename: Matthew L
authors.initials: ML
authors.lastname: Williams
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001011:Aorta / Q000601:surgery; D001013:Aorta, Thoracic / Q000601:surgery; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D001021:Aortic Valve / Q000601:surgery; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D019918:Heart Valve Prosthesis Implantation / Q000379:methods / Q000401:mortality; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007629:Kentucky / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010477:Perfusion / Q000379:methods; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome