Key result
Patients with uncomplicated acute type A aortic dissection had a significantly lower in-hospital mortality rate compared to those with complicated presentations (11.9% vs. 20.2%).
Why the study?
The study was conducted to clarify the short-term and mid-term outcomes of and prognostic factors for patients undergoing surgical repair for uncomplicated acute type A aortic dissection.
Cohort (n=603)
No
Absolute Event Rate: 11.9% vs 20.2%
p-value: p=0.007
Surgical repair of uncomplicated acute type A aortic dissection yields an acceptable in-hospital mortality rate of 11.9%, with mid-term survival remaining high for those who survive to discharge.
Acceptable mortality supports considering surgery in uncomplicated cases; leaves open need for randomized trials.
This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients' preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan-Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8-92.9%) and 83.1% (95% CI 76.8-87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.
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Lin et al. (2020) conducted a cohort in Acute type A aortic dissection (n=603). Uncomplicated acute type A aortic dissection vs. Complicated acute type A aortic dissection was evaluated on In-hospital mortality (p=0.007). Patients with uncomplicated acute type A aortic dissection had a significantly lower in-hospital mortality rate compared to those with complicated presentations (11.9% vs. 20.2%).
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