Outcomes of surgery for chronic type A aortic dissection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease

Background:

• Limited data exists on surgical outcomes for chronic Stanford type A aortic dissection.
• This study investigates primary surgery and long-term results in patients with chronic dissection of the native ascending aorta.

Purpose of the Study:

• To compare outcomes of surgery for chronic versus acute Stanford type A aortic dissection.
• To evaluate the feasibility and safety of resecting all dissected aortic tissue in chronic cases.

Main Methods:

• Retrospective analysis of 696 patients undergoing surgery for type A dissection between 1993 and 2013.
• Identified 67 patients (10%) with chronic dissection (>14 days) and compared them to acute dissection patients.
• Median follow-up was 4.1 years.

Main Results:

• Chronic dissection patients had higher rates of previous cardiac surgery, bicuspid aortic valve syndrome, and larger ascending aortic diameters.
• Moderate to severe aortic insufficiency was more frequent in the chronic group, requiring more aortic root replacements.
• In-hospital mortality was lower in the chronic group (4.5% vs. 13.2%), and overall survival was significantly better (80% vs. 68% at 5 years).
• Complete resection of dissected aortic tissue was achieved in 73% of chronic dissection patients.

Conclusions:

• Patients with chronic and acute type A aortic dissection present differently and have distinct outcomes.
• Surgical replacement of all dissected aortic tissue is safe and achievable for most patients with chronic type A aortic dissection.