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Does conservative surgical approach improve early and late outcome in patients with acute type A aortic dissection?
Kaan Kirali1, Denyan Mansuroğlu, Murat B Rabuş
1Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey. imkkirali@yahoo.com
Insights
Surgical approaches for acute type A aortic dissection (AAAD) show similar early and late outcomes. Early intervention and preventing complications are key to improving survival in AAAD patients.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Acute type A aortic dissection (AAAD) is a life-threatening emergency requiring immediate surgical intervention.
- Surgical strategy for AAAD depends on the extent of aortic involvement.
Purpose of the Study:
- To compare early and late outcomes of different surgical approaches for acute type A aortic dissection.
- To identify risk factors for mortality in AAAD patients.
Main Methods:
- Retrospective analysis of 61 patients undergoing surgery for AAAD.
- Classification of patients based on surgical extent: ascending aorta replacement (Group I) vs. aortic arch replacement (Group II).
- Classification based on aortic valve management: preserved (Group A) vs. replaced (Group B).
Main Results:
- Early mortality was 23%; significant risk factors included prior cardiac surgery, renal and cardiac complications, and longer pump time.
- Late mortality was 8.5%; pulmonary complications were the only significant independent risk factor.
- Neither aortic arch nor aortic valve replacement predicted mortality; survival rates did not differ significantly between surgical groups.
Conclusions:
- Both radical and conservative surgical strategies for AAAD yield comparable early and late results.
- Timely surgery before hemodynamic instability and proactive management of systemic complications enhance surgical outcomes in AAAD.
Objective:
Acute type A aortic dissection (AAAD) represents an emergency in cardiac surgery that requires immediate treatment to prevent death due to its fatal complications. The surgical approach is dependent on the involvement of AAAD.
Methods:
Sixty-one patients were operated for AAAD at our clinic. 48 (78.7%) were male and 13 (21.3%) were female with a mean age of 51+/-12.3 yr (range, 21-80 yr). Only the ascending aorta was replaced in 33 (54.1%) patients (Group I) and aortic arch replacement was included in 28 (45.9%) patients (Group II). The aortic valve was preserved in 43 (70.5%) patients (Group A) and replaced in 18 (29.5%) patients (Group B).
Results:
Early mortality rate was 23% (14/61). Multivariate analysis revealed that previous cardiac operations (P=0.048), renal complications (P=0.024), pump time (P=0.024), and cardiac complications (P=0.017) were significantly factors increasing early mortality. Late mortality rate was 8.5% (4/47) and multivariate analysis revealed that pulmonary complication (P=0.015) was the only statistically significant independent risk factor. Arch replacement or aortic valve replacement was not a predictor for early or late mortality. Cumulative survival was 73.8+/-5.63% at 1 yr and 68.3+/-6.46% at 7.5 yr. Cumulative survival was not different between groups (P>0.05).
Conclusions:
Both radical and conservative surgical approaches in AAAD do not differ in mean of early or late results. Surgery before development of hemodynamic instability and prevention of other system complications improves the outcome of surgical treatment in AAAD.