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Updated: Nov 25, 2025
Novel and Innovative Hybrid Technique for Type A Aortic Dissection
Published on: March 28, 2025
Current status of open surgery for acute type A aortic dissection in Japan
Yutaka Okita1, Hiraku Kumamaru2, Noboru Motomura3
1Takatsuki General Hospital, Takatsuki, Japan.
Insights
Open surgery for acute aortic dissection shows stable or decreasing in-hospital mortality in Japan. Despite acceptable early outcomes, further improvements are needed for patients with preoperative comorbidities.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Acute aortic dissection (AAD) is a life-threatening condition requiring timely surgical intervention.
- Open surgery remains a primary treatment modality for AAD.
- Understanding clinical outcomes is crucial for improving patient management.
Purpose of the Study:
- To report the clinical outcomes of open surgery for acute aortic dissection.
- To analyze trends in surgical volume and mortality.
- To identify areas for improvement in AAD treatment.
Main Methods:
- Analysis of the Japan Cardiovascular Database (2013-2018).
- Inclusion of 29,486 patients undergoing open surgery for AAD.
- Data collection on patient demographics, surgical procedures, and complications.
Main Results:
- In-hospital mortality was 11%, with a stable or decreasing trend over time.
- Major complications included stroke (12%), new hemodialysis (7.3%), and spinal cord ischemia (3.9%).
- Surgical volume increased, with 69% undergoing ascending aorta replacement and 29% total arch replacement.
Conclusions:
- Open surgery for AAD in Japan has seen increased volume and stable/decreasing mortality.
- Early outcomes are acceptable, but challenges remain, particularly for patients with comorbidities.
- Further research and optimized strategies are needed to enhance outcomes for high-risk AAD patients.
Objective:
The study objective was to report the clinical outcomes of open surgery for acute aortic dissection by using the Japan Cardiovascular Database.
Methods:
Between 2013 and 2018, a total of 29,486 patients with acute aortic dissection who underwent open surgery were registered in the Japan Cardiovascular Database. Some 50% of patients were male. Age of patients at surgery was 59.8 ± 14.2 years; 61% of patients were aged less than 65 years, and 21% of patients were aged more than 75 years. Connective tissue disease was found in 1.2% of patients. Some 13% of patients had disturbed consciousness, and 12% of patients had cardiogenic shock. Some 11% of patients had moderate or severe aortic valve regurgitation, and 2.3% of patients had acute myocardial infarction. Some 94% of patients underwent surgery within 24 hours after diagnosis. Antegrade cerebral perfusion was used in 74% of patients, hypothermic circulatory arrest with retrograde cerebral perfusion was used in 17.1% of patients, and deep hypothermic circulatory arrest was used in 9.4% of patients. Cardiopulmonary bypass time was 216 ± 90 minutes, and cardiac ischemic time was 132 ± 60 minutes. Lowest body temperature was 24.6°C ± 3.2°C. Replacement of the ascending aorta (zone I) was performed in 69% of patients, and total arch replacement (zone 0 to zone II, III-) was performed in 29% of patients. The aortic valve was replaced in 7.9% of patients and repaired in 4.4% of patients.
Results:
The 30-day mortality was 9.2%, and in-hospital mortality was 11%. The number of operations has increased through the study periods. The in-hospital mortality has been stable or in a decreasing trend. Major complications consisted of stroke in 12% of patients, new hemodialysis in 7.3% of patients, spinal cord ischemia in 3.9% of patients, and prolonged ventilation in 15% of patients.
Conclusions:
Approximately 30,000 patients with acute aortic dissection in the recent 6 years (2013 - 2018) underwent open surgery according to the nationwide Japanese database. The number of operations has increased, and in-hospital mortality has been stable or in a decreasing trend. Although the early outcomes are acceptable, there is still room for improvement in patients with preoperative comorbidities.
