PURPOSE: Surgical mortality and outcomes of type A aortic dissections remain very variable. Recently, studies have tried to establish a predictive model to identify mortality risks. We report our institutional experience.
METHODS: A review of our institutional database identified 164 cases of acute type A aortic dissection between 1/1/2000 to 12/31/2006. Fifty patients were classified as operative deaths. The demographics, preoperative cormobidities, cardiac status at time of surgery, and operative data were collected to assess the risk predictor for postoperative mortality by comparison between survivors and non-survivors.
RESULTS: The overall mortality was 30.5% among 164 cases. Patient's age was significantly higher among non-survivors (65.1±14 vs. 55±13 years, P=0.0001). There were more smokers (51.7% vs. 72%, P=0.025) and diabetes (4.4% vs. 18%, P=0.01) in non-survival group. Non-survivors also had higher rates of cardiac shock (16% vs. 4.4%, P=0.01), stable angina (36% vs. 16.7%, P=0.008) decreased left ventricular function (P<0.001) before surgery (10% vs. 0.9%, P=0.003) and longer bypass time (201.9±106.9 vs. 159.9±58.5min, P=0.014). The cross-clamping time, arrest time, retrograde cerebral perfusion time, and lowest core temperature were not obviously different between two groups (P>0.1). The aorta diameter was significantly larger with non-survivors (5.85±2.12 vs. 4.79±1.3 cm, P=0.03). Those patients whose procedure was done using tranesophageal echocardiogram had improved survival (65.8% vs. 44%, P=0.008). There was a trend the mortality decreased from 36.6% between 2000-2002 to 24.4% during 2003-2006, but P>0.05.
CONCLUSION: For patients undergoing surgery for type A aortic dissection, age, smoking, diabetes, cardiac shock, decreased left ventricular function, previous cardiac surgery, and size of aorta were predictive of surgical mortality. Use of TEE was associated with better outcomes.
CLINICAL IMPLICATIONS: Patients characteristics affect postoperative survival more than surgical factors.
DISCLOSURE: Peter Hill, No Financial Disclosure Information; No Product/Research Disclosure Information