Outcomes of surgery for chronic type A aortic dissection

Data on outcomes of surgery for chronic Stanford type A aortic dissection are limited. We investigated the primary surgery and long-term results in patients with chronic dissection of the native ascending aorta.

Between 1993 and 2013, among 696 patients (median age, 61 years [first quartile, 50; third quartile 73 years]; 64% males) who underwent surgery for type A dissection, 67 (10%) had chronic dissection by traditional criteria (>14 days). Median follow-up was 4.1 years (first quartile, 1.9; third quartile, 7.3 years; 3,105 patient-years).

Patients with chronic dissection more frequently had undergone previous cardiac surgery (37% versus 9%; p < 0.001) and more frequently had bicuspid aortic valve syndrome (19% versus 7%; p < 0.001) and larger ascending aortic diameter (6.0 cm [first quartile 5.2; third quartile 7.2 cm] versus 4.9 cm [first quartile, 4.5; third quartile, 5.7 cm]; p < 0.001). Aortic dissection extended beyond the aortic arch less frequently in chronic dissection patients (27% versus 70%; p < 0.001). Moderate to severe aortic insufficiency rate was higher in chronic group (65% versus 36%; p < 0.001); they required aortic root replacement more frequently (42% versus 18%; p < 0.001) and had lower in-hospital mortality (4.5% versus 13.2%; p = 0.062). Resection of all dissected aortic tissue was achieved in 73% chronic and 30% acute dissection patients. Overall survival was better in the chronic group with 80% ± 5% versus 68% ± 2% at 5 years and 64% ± 13% versus 49% ± 3% at 10 years (log rank p = 0.021).

Patients with chronic and acute type A dissection differ substantially in presentation, management, and outcome. Replacement of all dissected aortic tissue can be performed safely in the majority of patients with chronic type A dissection.