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Dissection of the aorta and dissecting aortic aneurysms. Improving early and long-term surgical results
L G Svensson1, E S Crawford, K R Hess
1Department of Surgery, Baylor College of Medicine, Houston, TX 77030.
Insights
Surgical intervention for aortic dissection has significantly improved over time. Modern techniques yield high survival rates, approaching 95%, with better long-term outcomes for patients with aortic dissection.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Aortic dissection is a life-threatening condition often requiring complex surgical management.
- A significant portion of patients (24%) presented with aortic dissection as a complication of prior aortic or cardiac surgery.
- Treatment strategies evolved over a 33-year period, impacting surgical outcomes.
Purpose of the Study:
- To report surgical results for aortic dissection over an extended period (1956-1989).
- To identify determinants of early and late mortality in patients undergoing surgery for aortic dissection.
- To evaluate the impact of evolving surgical techniques on survival rates.
Main Methods:
- Retrospective analysis of 690 consecutive patients with aortic dissection.
- Classification of dissections based on the most affected aortic segment: ascending aorta/aortic arch, descending thoracic aorta, and thoracoabdominal aorta.
- Identification of independent determinants for mortality, reoperation, and complications.
Main Results:
- Markedly improved 30-day operative survival rates over time, approaching 95% for acute dissections.
- Identification of independent predictors for early and late mortality.
- Improved late results and survival for patients undergoing aggressive surgical intervention.
Conclusions:
- Continued aggressive surgical intervention for aortic dissection using modern techniques leads to significantly improved survival.
- Understanding determinants of mortality aids in optimizing patient management and surgical planning.
- Surgical management of aortic dissection has evolved, offering better prognoses for affected individuals.
Abstract:
We report the improving surgical results in a consecutive series of 690 patients referred to one of us (E.S.C.) for aortic dissection between December 1956 and September 1989, a substantial portion of whom had dissection as a complication of either previous aortic (n = 113, 16) or previous cardiac (n = 54, 8%) operation. Our initial operation of choice in patients requiring multiple operations in this group of 690 patients was based on the most life-threatening or symptomatic aortic segment involved, which was ascending aorta and/or aortic arch (Asc/Arch) in 301 (44%) patients, descending thoracic aorta (Desc) in 195 (28%) patients, and thoracoabdominal aorta (TaA) in 194 (28%) patients. As detailed below, considerable improvement occurred in the 30-day survival rates over time, particularly for acute dissection: [table; see text] The independent determinants of both early and long-term mortality were identified. Independent determinants of late fatal rupture, reoperation, and neuromuscular dysfunction for distal dissectors were also identified. In our experience, continued aggressive surgical intervention for aortic dissection with modern operative techniques has resulted in markedly improved 30-day operative survival (approaching 95% including those patients with acute dissection) and significant improvement in late results.