title: Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era.
abstract: OBJECTIVE
  The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection during 2000-2005 and 2006-2010.
  
  
  METHODS
  A total of 251 patients from four academic medical centres underwent repair of acute type A aortic dissection between January 2000 and October 2010. Of those, 111 patients underwent repair during 2000-2005, whereas 140 patients underwent repair during 2006-2010. Median ages were 62 years (range 20-83) and 58 years (range 30-80) for patients repaired from 2000-2005 compared with those repaired during 2006-2010, respectively (P = 0.180). Major morbidity, operative mortality and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality.
  
  
  RESULTS
  Operative mortality was strongly influenced by surgical era (24% for 2000-2005 vs 12% for 2006-2010, P = 0.013). In multivariable logistic regression analysis, haemodynamic instability [odds ratio (OR) = 17.8, 95% confidence intervals (CIs) = 0.05-0.35, P <0.001], cardiopulmonary bypass time >200 min (OR = 9.5, 95% CI = 0.14-0.64, P = 0.002) and earlier date of surgery (OR = 5.8, 95% CI = 1.18-5.14, P = 0.016) emerged as independent predictors of operative mortality. Actuarial 5-year survival was worse for earlier compared with later date of surgery (64% for 2000-2005 vs 77% for 2006-2010, log-rank P <0.001).
  
  
  CONCLUSIONS
  Surgical era significantly impacts early outcomes and actuarial survival following repair of acute type A aortic dissection.
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
authors.forename: Brian D
authors.initials: BD
authors.lastname: Conway
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA cvsisfun@hotmail.com.
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.affiliation: Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, USA.
authors.forename: Nicholas T
authors.initials: NT
authors.lastname: Kouchoukos
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, USA.
authors.forename: Kevin W
authors.initials: KW
authors.lastname: Lobdell
authors.affiliation: Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, USA.
authors.forename: Kamal R
authors.initials: KR
authors.lastname: Khabbaz
authors.affiliation: Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, USA.
authors.forename: Edward
authors.initials: E
authors.lastname: Murphy
authors.affiliation: Department of Cardiac Surgery, Hartford Hospital, Hartford, USA.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
mesh_terms: D000046:Academic Medical Centers; D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D016009:Chi-Square Distribution; D016208:Databases, Factual; D057510:Endovascular Procedures / Q000009:adverse effects / Q000401:mortality; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D058996:Quality Improvement; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D055815:Young Adult
keywords: Acute type A aortic dissection; Surgery; Survival