Type A Symptomatic proximal aortic dissection presentation and outcomes of 138 patients surgically managed (1992-2001)

pp 369-376

Abstract

Objective 
To assess the presentation and outcomes of type A aortic dissection (DATA) and to establish predictors of in-hospital and long-term mortality. 

Methods 
From 2/92 - 5/01, 138 consecutive patients (pts) severely symptomatic with DATA and an undisputed diagnostic test were included. Sur­gical strategies were valve resuspension with supracoronary aortic root repair and ascend­ing aortic graft in 99 pts (71.7%), composite valve and ascending aortic graft (Bentall or Cabrol operation) in 37 pts (26.8%) ,and M Yacoub technique in two cases (1.4%). Concomi­tant CABG was performed in 20 pts (14.5%). 

Results 
In 106 pts (76.8%) DAPS was acute and in 32 (23.2%) it was chronic. Mean age of patients was 57.6±13.4 years. Chest pain was present in 124 patients (90%) and dyspnoea in 32 (23%). The main surgical complications were: hypoxemia (62.3%), low cardiac output (50%) and renal fail­ure (47.1%). In-hospital mortality was 28.2% (39 patients). Multivariate analysis identified age, previous renal dysfunction, neurovegetative symptoms, days after the onset of symptoms and heart rate > 90 as independent predictors of mortality. Mean follow up was 37.5±29 months. Kaplan Meier estimated (%, CI 95%) survival at 1, 2 and 3 years was 92,7 (87.3-98.5), 91(84.7-97.7) and 79.6 (70-90.5) respectively. 

Conclusions 
DATA was specially common among hypertensive male patients, with severe chest pain as initial symptom. In-hospital mortality was related to age, previous renal dysfunction, neurovegetative symptoms, days after the on­set of symptoms and heart rate at presentation. Long-term survival was good and in accordance to other series.