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Prognosis after non-surgical therapy for acute type A aortic dissection
Koki Yokawa1, Shigeki Koizumi1, Mio Kasai1
1Department of Cardiovascular Surgery, National Cerebral and Cardiovascular Center, 6-1 Kishibe-Shimmachi, Suita, Osaka, 564-8565, Japan.
General Thoracic and Cardiovascular Surgery
|February 25, 2024
Summary
Stanford type A acute aortic dissection (AAAD) carries a high mortality risk, especially for elderly patients unsuitable for or refusing surgery. Conservative management yields a 37% in-hospital mortality for those refusing surgery, with acceptable long-term survival for survivors.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Vascular Surgery
Background:
- Stanford type A acute aortic dissection (AAAD) typically requires immediate surgical intervention for survival.
- Elderly patients or those with comorbidities present unique challenges for surgical management of AAAD.
Purpose of the Study:
- To evaluate the outcomes of non-surgical management in patients with AAAD who were either unsuitable for surgery or declined the procedure.
- To provide data for informed decision-making regarding treatment options for AAAD in elderly or high-risk populations.
Main Methods:
- A cohort of 35 patients with AAAD, deemed ineligible for surgery or refusing it, were analyzed.
- Patients were categorized into surgical ineligibility (n=8, mean age 84.5) and surgical refusal (n=27, mean age 88.0) groups.
- Outcomes including in-hospital mortality, causes of death, and mid-term survival were assessed.
Main Results:
- The overall in-hospital mortality for the study cohort was 51.4%.
- Mortality was 100% for surgically ineligible patients and 37% for those who declined surgery.
- Mid-term survival for hospital survivors who declined surgery was 81.9% ± 9%.
Conclusions:
- Non-surgical management of AAAD in elderly, high-risk patients results in significant mortality, particularly for those deemed inoperable.
- For patients fit for surgery but refusing it, a 37% in-hospital mortality highlights the risks of conservative treatment.
- These findings offer a crucial benchmark for shared decision-making between patients, families, and clinicians regarding AAAD treatment.
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