Medium-term survival after surgery for acute Type A aortic dissection is improving

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• Acute Type A aortic dissection (AATA) is a life-threatening condition requiring urgent surgical intervention.
• Long-term outcomes and mortality predictors for AATA remain critical areas for research.
• The Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD) database provides a valuable resource for studying AATA outcomes.

Purpose of the Study:

• To report long-term survival rates in patients with AATA.
• To identify pre- and intraoperative predictors of mortality in AATA patients.
• To evaluate survival trends over time within the NORCAAD registry.

Main Methods:

• Analysis of data from the NORCAAD registry, a multicentre, multinational database of 1159 patients operated on between 2005 and 2014.
• Application of Kaplan-Meier and Cox proportional hazard models to assess medium-term survival (up to 8 years) and relative survival against a matched normal population.
• Identification of mortality predictors using multivariable analysis, reporting hazard ratios (HR) and 95% confidence intervals (95% CI).

Main Results:

• Overall survival at 1, 5, and 8 years was 95%, 86%, and 76%, respectively.
• Relative survival at 1, 5, and 8 years was 95%, 90%, and 85%, respectively, indicating outcomes close to the general population.
• Increased age, prior aortic repair, and chronic renal disease were associated with higher mortality, while open distal anastomosis and later surgical period (2010-2014) were linked to improved survival.

Conclusions:

• Medium-term survival following AATA surgery within the NORCAAD registry is satisfactory and has improved over time.
• Outcomes for AATA patients are approaching those of the general population.
• The adoption of open distal anastomosis technique is associated with reduced medium-term mortality.