Outcome and quality of life after treatment for acute type a aortic dissection: a single center experience

Objectives: Operations for AADA requiring deep hypothermic circulatory arrest (HCA) are still associated with significant morbidity and mortality, despite the fact that different cerebral protection methods are currently in use. The aim of this study was to asses outcome and quality of life after surgery for AADA using our institutional database and a standard questionary survey (SF-36).

Methods: Between 01/96 and 05/2004, 149 consecutive patients (54 female) were treated for AADA in our institution. Median age was 60 (16–85). Twenty-three presented with aortic rupture, haemodynamic instability was present in 39 and new neurological dysfunction occurred in 34. Fifty were operated with HCA alone, in 99 selective antegrade cerebral perfusion (SACP) was used as an adjunctive. Follow-up data were obtained by direct telephone contact to the patient or the general practitioner.

Results: Early mortality was 24%. Temporary neurological dysfunction occurred in 33 patients (HCA 13, SACP 20, p=ns), permanent neurological dysfunction dysfunction in 35 patients (HCA 20, SACP 15, p<0.01). Follow-up was completed in 92% (41 month). Twenty patients died during follow-up. The SF-36 questionary was correctly answered in 74 cases (89%). Patients treated with SACP showed a significant better performance in their physical status postoperatively (p<0.05), but their were no significant differences in the mental status (p=0.3).

Conclusions: Brain protection by using SACP can reduce the incidence of postoperative neurological complications compared to HCA alone. Survey analysis revealed higher scores concerning the physical status. Therefore further efforts are necessary to improve the cognitive integrity during repair of AADA.