Predictors for mortality and long-term survival after acute type-A aortic dissection: Single institutional experience of 836 cases

Objectives: Acute type-A aortic dissection is considered an emergency indication for surgery. We retrospectively assessed our data over a 15-year period starting in 1996. No patients are excluded from immediate operation irrespective of age and preoperative status unless uncontrollable hemorrhage and/or cardiac arrest occurs before the patient reaches the operating room. This study was designed to explore predictive factors for mortality and long-term survival in patients with acute type-A aortic dissection.

Methods: Between 01/1996 and 09/2011, 836 patients (559 men) with a mean age of 59.6 ± 13.6 (range 18 – 92) years underwent surgery for acute type-A aortic dissection. The data of patients were analyzed retrospectively with univariable testing and multivariable logistic regression analysis to identify predictors of mortality. The Kaplan-Meier survival curve was constructed to depict cumulative survival in all patients. In most cases hypothermic circulatory arrest was induced to allow open inspection of the aortic arch and its repair when indicated.

Results: The overall 30-day mortality was 22.3%. The mortality rate was 9.8% in young patients aged < 45 years and 34.6% in older patients aged ≥80 years. The overall mortality reduced to 18.3% in the last 5 years. Factors associated with increased 30-day mortality on univariable analysis were age (each year increases the mortality by 3%, OR 1.03, 95% CI, 1.01 to 1.04, P < 0.001), preoperative LVEF (OR 0.94, 95% CI 0.93 to 0.96, P < 0.001), postoperative creatinine value (OR 1.33, 95% CI 1.21 to 1.47, P < 0.001), and aortic clamping time (OR 2.31, 95% CI 1.72 to 3.13, P < 0.001). The long-term survival and freedom from reoperation at 1, 5 and 10 years of follow-up were 70.5%, 58.5%, 42.1% and 96.4%, 91.2%, 88.8%, respectively.

Conclusions: Emergency surgery for acute type-A aortic dissection is associated with relatively high mortality, which is influenced by institutional experience and patients' preoperative condition.