Relationship between primary entry tear and surgical outcomes for acute type A aortic dissection: A single-center experience

Introduction: The location of the primary entry tear not only affects the prognosis but also the treatment strategy for aortic dissection. This study evaluated the relationship between the primary entry tear and surgical outcomes for acute type A aortic dissection. Patients and methods: A retrospective descriptive study of consecutive patients with acute type A aortic dissection who underwent surgery at Viet Duc University Hospital between 2021 and 2022. Results: There were 89 patients included in this study. The primary entry tear in the ascending aorta accounted for 43.8%; the group with the primary entry tear in the aortic arch and the group with the primary entry tear in the descending aorta had quite an equal percentage. False lumen thrombosis most frequently occurred in the group with primary entry tear in the descending aorta. The location of the primary entry tear influenced the surgical technique, in which the majority of patients with primary entry tears at the aortic arch underwent hemiarch or total arch replacement. Postoperatively, the early mortality rate and early reoperation rate were 11.2% and 5.6%, respectively. The most common cause of early death was multiorgan failure, and the most common cause of reoperation was bleeding. The early mortality rate tended to be higher in the group with lesions at the aortic arch (p = 0.08), while those with primary entry tears at the ascending aorta showed more bleeding complications (p = 0.07). Conclusion: Acute type A aortic dissection is a life-threatening disease with a high mortality rate. The location of the primary entry tear plays an important role in planning surgical treatment and predicting the initial outcomes of surgery as well as the long-term progression of this disease after surgery.