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Surgery for Type A Aortic Dissection: 14-Year Contemporary Cohort Study
Tom Kai Ming Wang1, Danting Wei1, Thomas Evans2
1Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Cardiology, Middlemore Hospital, Auckland, New Zealand.
Insights
Type A aortic dissection surgery is increasing, with high mortality and morbidity rates. However, operative mortality has decreased since 2014, and prognosis is good after surviving the perioperative period.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Aortic Disease
Background:
- Type A aortic dissection is a life-threatening condition requiring immediate surgical intervention.
- Understanding contemporary trends and outcomes is crucial for improving patient care.
Purpose of the Study:
- To review trends, patient characteristics, surgical outcomes, and predictors of mortality and morbidity for Type A aortic dissection.
- To analyze a 14-year surgical experience at a single center.
Main Methods:
- Prospective data collection on consecutive patients undergoing Type A aortic dissection surgery from March 2003 to March 2017.
- Statistical analysis of patient demographics, preoperative status, operative details, and outcomes.
Main Results:
- 327 patients were included; surgeries increased significantly after 2010.
- Operative mortality was 19.9%, decreasing to 14.0% since 2014.
- Critical preoperative state and malperfusion syndrome independently predicted adverse outcomes.
Conclusions:
- Surgery for acute Type A aortic dissection is increasing, with persistent high morbidity.
- While operative mortality has decreased, critical preoperative state and malperfusion remain key predictors of adverse outcomes.
- Patients surviving the perioperative period have a favorable long-term prognosis.
Background:
Type A aortic dissection is a fatal condition warranting emergency surgery to prevent complications and death. We reviewed the contemporary trends, characteristics, outcomes and predictors of this operation at our centre over a 14-year period.
Methods:
Consecutive patients undergoing type A aortic dissection surgery at Auckland City Hospital during March 2003-March 2017 were studied, and relevant characteristics and outcomes collected prospectively for statistical analyses.
Results:
There were 327 patients included, and the number of operations each year remained similar from 2003-2010, and steadily increased thereafter. Median age was 60.6 years, with 124 (37.9%) females, 136 (41.6%) Maori or Pacific ethnicity, 319 (97.6%) emergency surgeries, 62 (19.0%) in a critical preoperative state and 154 (47.1%) having a malperfusion syndrome. Operative mortality occurred in 65 (19.9%), although this has decreased from 23.3% before 2014 to 14.0% since. Composite morbidity occurred in 212 (65.0%), predominantly acute kidney injury 134 (41.0%), ventilation >24 hours (129 (39.6%), return to theatre 94 (28.8%) and stroke 63 (19.3%). Survival at 1, 5 and 10 years was 79.0%, 71.7% and 57.8% respectively. Critical preoperative state and malperfusion syndrome were independent predictors of operative and long-term mortality and composite morbidity.
Conclusion:
Surgery for acute type A aortic dissection has been increasing since 2011 and continues to have high rates of operative mortality and morbidities, although the former has decreased since 2014. Critical preoperative state and malperfusion were the key predictors of adverse outcomes. After surviving the perioperative period, prognosis was good with low rates of late mortality.
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