Does Duration of Aortic Cross Clamp Affect Outcome in Patients Undergoing Surgical Repair of Acute Dissection of Aorta Type A? A Large Retrospective Cohort Study

Background: Acute aortic dissection type A (AADA) is a complex pathology associated with high mortality rate and postoperative complications. Perioperative management and surgical techniques have improved allowing for reasonable postoperative outcome. This study aims to investigate the outcome depending on aortic cross clamp duration (ACC).

Method: A total of 473 consecutive patients with AADA between 2001 and 2021 were included. Patients were divided in two groups: ACC ≤120 minutes and ACC >120 minutes and compared for differences by univariate statistics. Survival was estimated by Kaplan–Meier method and log-rank test was used to compare survival distributions between groups.

Results: ACC was more than 120 minutes in one-third of patients (33.2 vs. 66.8%). Cardiopulmonary bypass, circulatory arrest, and surgery times were concordantly longer in this group. Lactate immediately after surgery was 4.1 versus 3.2 mmol/L (p = 0.006) and equal at 1.1 mmol/L (p = 0.36) on the 2nd day after surgery. Creatinine levels on first postoperative day (109 vs. 104 µmol/L) as well as 1 week after surgery (89 vs. 83 µmol/L) were nonsignificantly disparate. CK-MB immediately after surgery was higher in the ACC >120-minute group due to longer ischemia times (80 vs. 52 U/L) but came to level on 8th postoperative day (15 vs. 13 U/L). Duration of postoperative intensive care stay was 6 versus 5 days (2–13 vs. 2–10, p = 0.252) and number of days until discharge after surgery was 11 versus 10 days (7–18 vs. 6–18, p = 0.435). There were no significant differences between both groups concerning postoperative complications. Rethoracotomy was nonsignificantly seen more often in patients with ACC >120 minutes (21.2 vs. 17.8%; p = 0.378). Mortality in patients with ACC >120 minutes was low and nonsignificantly different from those ACC ≤120 minutes: 7-day mortality, 13.5 vs. 9.6% (p = 0.208); 30-day mortality, 20 vs. 16.2% (p = 0.306). Long-term survival was not significantly lower in the ACC >120 minutes group (p = 0.203).

Conclusion: Despite complex procedures, the outcome is hugely satisfying for both groups regardless of ACC. Differences between the two groups can be explained by varying complexness of therapy and surgical strategies and techniques but all lead to comparable outcome and low complication rate. This study shows that longer surgery times respectively cross clamping can be tolerated as modern perioperative management allows for favorable results in both groups.

Publication History

Article published online:
28 January 2023