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Operative experience with 50 thoracic aortic dissections

D B Stephens, D A Killen, W A Reed

    Southern Medical Journal
    |December 1, 1982
    PubMed
    Summary
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    Surgical repair of thoracic aortic dissection showed a 14% operative mortality. Survival rates were lower for acute Type A dissections, highlighting the need for prompt intervention in these critical cases.

    Area of Science:

    • Cardiovascular Surgery
    • Thoracic Aortic Disease
    • Vascular Surgery

    Background:

    • Thoracic aortic dissection is a life-threatening condition requiring surgical intervention.
    • Understanding outcomes based on dissection type and acuity is crucial for patient management.

    Purpose of the Study:

    • To evaluate the operative mortality and long-term survival following surgical repair of thoracic aortic dissection.
    • To compare outcomes between Type A and Type B dissections, and between acute and chronic presentations.

    Main Methods:

    • Retrospective analysis of 50 surgical operations performed on 46 patients with thoracic aortic dissection between 1971 and 1981.
    • Classified dissections into Type A (ascending) and Type B (descending), and subgrouped by acuity (acute <2 weeks, chronic >2 weeks).

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  • Documented surgical procedures including graft replacement, aortoplasty, aortorraphy, and bypass.

    • Main Results:

    • Overall operative mortality was 14% (7 deaths).
    • Acute Type A dissections had the highest operative mortality (20%), while chronic Type A had 7%.
    • Type B dissections had a low operative mortality (1/12). Overall cumulative survival was 70% at 4 years, decreasing to 45% at 6 years, with poorest survival in acute Type A (38.9% at 5 years).

    Conclusions:

    • Surgical repair of thoracic aortic dissection carries significant operative risk, particularly for acute Type A dissections.
    • Long-term survival is suboptimal, emphasizing the need for improved treatment strategies and early intervention.
    • Iatrogenic dissections contributed to a notable proportion of hospital deaths.