title: The outcome of surgical management of type A aortic dissection.
abstract: BACKGROUND
  Type A aortic dissection is a serious and fatal condition.
  
  
  METHODS
  We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5 ± 13.8 years, who were treated between 2006 and 2011. Most patients were male (70, 65%).
  
  
  RESULTS
  Circulatory arrest with a mean duration of 22 ± 16 min was performed in 42 (38.9%) patients. Perioperative mortality was 15.7% (n = 17). Univariate analysis showed that cardiopulmonary bypass time (p = 0.0006), age >60 years (p = 0.028), cardiogenic shock at presentation (p = 0.02), New York Heart Association class II-IV (p = 0.038), hemopericardium (p = 0.0035), and preoperative cerebrovascular accident (p = 0.02) were predictors of mortality. Multivariate analysis indicated that age >60 years (odds ratio 7.7, 95% confidence interval: 1.52-38.96, p = 0.0136), preoperative cerebrovascular accident (odds ratio 25.2, 95% confidence interval: 2.45-258.9, p = 0.0066), hemopericardium (odds ratio 41.6, 95% confidence interval: 5.38-320.7, p = 0.0003), and cardiopulmonary bypass time (odds ratio 1.85, 95% confidence interval: 1.32-2.57, p = 0.0003) were independent predictors of perioperative mortality. The 1- and 4-year survival was 80% ± 3.8% and 69% ± 5.7%, respectively. Age >60 years (hazard ratio 3.3, 95% confidence interval: 1.4-7.9, p = 0.0064) was the only independent predictor of long-term mortality.
  
  
  CONCLUSIONS
  Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.
authors.affiliation: Department of Cardiovascular and Thorscic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
authors.forename: Edvard
authors.initials: E
authors.lastname: Skripochnik
authors.affiliation: Department of Cardiovascular and Thorscic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
authors.forename: Patricia
authors.initials: P
authors.lastname: Friedman
authors.affiliation: Department of Cardiovascular and Thorscic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA.
authors.forename: Robert E
authors.initials: RE
authors.lastname: Michler
authors.affiliation: Staten Island University Hospital, Department of Cardiothoracic Surgery, New York, USA siyamekneragi@yahoo.com.
authors.forename: Siyamek
authors.initials: S
authors.lastname: Neragi-Miandoab
mesh_terms: D000367:Age Factors; D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D000072226:Computed Tomography Angiography; D005260:Female; D006324:Heart Arrest, Induced; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome
keywords: Aneurysm; aortic aneurysm; cardiopulmonary bypass; dissecting; risk factors; survival rate; thoracic; vascular surgical procedures