The outcome of surgical management of type A aortic dissection

Background: Type A aortic dissection is a serious and fatal condition. Methods: We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5±13.8 years, who were treated between 2006 and 2011. Most patients were male (70, 65%). Results: Circulatory arrest with a mean duration of 22±16 min was performed in 42 (38.9%) patients. Perioperative mortality was 15.7% (n=17). Univariate analysis showed that cardiopulmonary bypass time (p=0.0006), age >60 years (p=0.028), cardiogenic shock at presentation (p=0.02), New York Heart Association class II-IV (p=0.038), hemopericardium (p=0.0035), and preoperative cerebrovascular accident (p=0.02) were predictors of mortality. Multivariate analysis indicated that age >60 years (odds ratio 7.7, 95% confidence interval: 1.52±38.96, p=0.0136), preoperative cerebrovascular accident (odds ratio 25.2, 95% confidence interval: 2.45-258.9, p=0.0066), hemopericardium (odds ratio 41.6, 95% confidence interval: 5.38-320.7, p=0.0003), and cardiopulmonary bypass time (odds ratio 1.85, 95% confidence interval: 1.32-2.57, p=0.0003) were independent predictors of perioperative mortality. The 1- and 4-year survival was 80%±3.8% and 69%±5.7%, respectively. Age >60 years (hazard ratio 3.3, 95% confidence interval: 1.4-7.9, p=0.0064) was the only independent predictor of long-term mortality. Conclusion: Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.