Outcome After Surgery for Acute Type A Aortic Dissection With or Without Primary Tear Resection

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Aortic Disease Research

Background:

• Outcomes for acute type A aortic dissection (aTAAD) surgery without primary tear replacement remain unclear.
• A significant portion of aTAAD patients have unrecorded primary tear locations, complicating outcome analysis.
• Previous studies lack definitive conclusions on the impact of primary tear resection on patient prognosis.

Purpose of the Study:

• To evaluate the midterm outcomes of patients undergoing surgery for acute type A aortic dissection.
• To compare survival and reoperation rates between patients with and without resection of the primary tear site.
• To determine if primary tear resection is a significant factor in the prognosis of aTAAD patients.

Main Methods:

• Retrospective analysis of 1122 patients undergoing aTAAD surgery across 8 Nordic centers (2005-2014).
• Exclusion of 243 patients with unknown or unconfirmed primary tear locations.
• Comparison of outcomes between the tear resected (TR, n=730) and tear not resected (TNR, n=149) groups using adjusted restricted mean survival time ratios.

Main Results:

• No significant difference in all-cause mortality between TR and TNR groups (adjusted RMST ratio: 1.01; P=.799).
• No significant difference in aortic reoperation-free survival between TR and TNR groups (adjusted RMST ratio: 0.98; P=.436).
• Primary tear location was predominantly in the ascending aorta for the TR group (83.6%).

Conclusions:

• Primary tear resection alone is not a determinant of midterm outcomes in acute type A aortic dissection surgery.
• Surgical strategies for aTAAD should consider factors beyond primary tear resection for optimizing patient prognosis.
• Further research is needed to identify other key prognostic indicators in aTAAD management.