Original article
Cardiovascular
Long-Term Results After 27 Years of Surgical Treatment of Acute Type A Aortic Dissection

https://doi.org/10.1016/j.athoracsur.2005.02.059Get rights and content

Background

This study investigates the determinants of long-term outcome and modalities of late death after surgical treatment of acute type A dissection.

Methods

Between 1974 and 2001, 315 consecutive patients were operated on for acute type A aortic dissection. Operative mortality was 22.9%. A series of 243 survivors of surgical treatment were followed up for as long as 27 years. Endpoints were death, cardiovascular reoperation, and neurologic events. Median follow-up was 4.5 years. Follow-up was 99.6% complete.

Results

Cumulative survival of discharged patients was 96.4% ± 1.3%, 67.7% ± 4.7%, and 39.4% ± 12.0% at 1, 10, and 20 years, respectively. During follow-up, 47 patients died. Cause of death was cardiac failure in 7, hemorrhage due to rupture of the distal aorta in 7, stroke in 4, respiratory insufficiency in 4, sepsis in 3, malignancy in 2, and unknown in 20 patients. Multivariate analysis revealed advanced patient age and postoperative hemodialysis as perioperative indicators of late death (p < 0.05). Freedom from cardiovascular reoperation was 90.7% ± 2.0% at 1 year, 60.9% ± 5.1% at 10 years and 41.9% ± 15.0% at 20 years. A total of 58 patients required 86 cardiovascular reoperations; aortic root or ascending aorta replacement was performed in 20, distal ascending aorta and arch replacement in 13, descending aorta replacement in 6, thoracoabdominal aorta replacement in 7, abdominal aorta replacement in 7, and miscelleanous reoperations in 6 patients. Multivariate analysis revealed male sex and left coronary artery dissection as significant determinants for late cardiovascular reintervention (p <0.05). Cumulative incidence of stroke after 20 years was 3.8%.

Conclusions

Acute type A dissection represents an emergency situation with acceptable long-term results for discharged survivors of surgical treatment.

Section snippets

Material and Methods

Between November 1974 and December 2001, 315 consecutive patients (205 men and 110 women) were operated on for acute type A aortic dissection at the St. Antonius Hospital, Nieuwegein, The Netherlands. The mean patient age was 58 ± 12 years. If chest pain or other symptoms occurred less than 14 days before operation, the dissection was defined as acute [5]. The type of the aortic dissection was considered, according to the Stanford classification, to be type A if the ascending aorta was involved

Survival

The overall operative mortality rate was 22.9%; 243 patients survived surgical treatment and were discharged from the hospital. Among the discharged patients, cumulative survival was 96.4% ± 1.3%, 67.7% ± 4.7%, and 39.4% ± 12.0% at 1, 10, and 20 years, respectively (Fig 1). Median survival time was 16.0 years. During the follow-up period, 47 patients died (19.3%). Seven patients died of cardiac failure, 7 patients had fatal rupture of the distal aorta, and 4 patients died of a stroke (Table 1).

Comment

We have reviewed the late results for 243 discharged patients who survived surgical treatment for acute type A dissection. The results indicate that the variables found to influence the long-term results were all associated with preoperative patient-related factors and with a certain seriousness and extent of the disease, which for the most part cannot be readily modified. This is similar to previous reports in which late results were shown to depend upon both technical features of the

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