title: Effects of Hemodynamic Instability on Early Outcomes and Late Survival Following Repair of Acute Type A Aortic Dissection.
abstract: BACKGROUND
  The goal of this study was to compare operative mortality and actuarial survival between patients presenting with and without hemodynamic instability who underwent repair of acute Type A aortic dissection. Previous studies have demonstrated that hemodynamic instability is related to differences in early and late outcomes following acute Type A dissection occurrence. However, it is unknown whether hemodynamic instability at the initial presentation affects early clinical outcomes and survival after repair of Type A aortic dissection.
  
  
  METHODS
  A total of 251 patients from four academic medical centers underwent repair of acute Type A aortic dissection between January 2000 and October 2010. Of those, 30 presented with hemodynamic instability while 221 patients did not. Median ages were 63 years (range 38-82) and 60 years (range 19-87) for patients presenting with hemodynamic instability compared to patients without hemodynamic instability, respectively (P = 0.595). Major morbidity, operative mortality, and 10-year actuarial survival were compared between groups.
  
  
  RESULTS
  Operative mortality was profoundly influenced by hemodynamic instability (patients with hemodynamic instability 47% versus 14% for patients without hemodynamic instability, P < 0.001). Actuarial 10-year survival rates for patients with hemodynamic instability were 44% versus 63% for patients without hemodynamic instability (P = 0.007).
  
  
  CONCLUSIONS
  Hemodynamic instability has a profoundly negative impact on early outcomes and operative mortality in patients with acute Type A aortic dissection. However, late survival is comparable between hemodynamically unstable and non-hemodynamically unstable patients.
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
authors.forename: Brian D
authors.initials: BD
authors.lastname: Conway
authors.affiliation: Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa;
authors.forename: Sotiris C
authors.initials: SC
authors.lastname: Stamou
authors.affiliation: Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri;
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, North Carolina;
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, Massachusetts;
authors.forename: Kamal
authors.initials: K
authors.lastname: Khabbaz
authors.affiliation: Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan; and.
authors.forename: Lawrence H
authors.initials: LH
authors.lastname: Patzelt
authors.affiliation: Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut.
authors.forename: Robert C
authors.initials: RC
authors.lastname: Hagberg
keywords: Aortic dissection; Hemodynamics; Surgery