Key result
Recent era of acute type A dissection repair linked to operative mortality halving vs earlier era.
Why the study?
Early postoperative outcomes and long-term survival after repair of acute type A aortic dissection may have improved over time but have not been directly compared between surgical eras.
Does surgical repair of acute type A aortic dissection in the more recent era (2006-2010) improve operative mortality and 5-year survival compared to an earlier era (2000-2005)?
Cohort (n=251)
Yes
Does surgical repair of acute type A aortic dissection in the more recent era (2006-2010) improve operative mortality and 5-year survival compared to an earlier era (2000-2005)?
Odds Ratio: 5.8 (95% CI 1.18–5.14)
Absolute Event Rate: 24% vs 12%
p-value: p=0.016
Surgical outcomes and 5-year survival for acute type A aortic dissection repair have significantly improved in the more recent era (2006-2010) compared to the earlier era (2000-2005).
Improved operative mortality and 5-year survival in later era; supports ongoing refinements in acute type A dissection management.
OBJECTIVES: The goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection during 2000-2005 and 2006-2010. METHODS: A total of 251 patients from four academic medical centres underwent repair of acute type A aortic dissection between January 2000 and October 2010. Of those, 111 patients underwent repair during 2000-2005, whereas 140 patients underwent repair during 2006-2010. Median ages were 62 years (range 20-83) and 58 years (range 30-80) for patients repaired from 2000-2005 compared with those repaired during 2006-2010, respectively (P = 0.180). Major morbidity, operative mortality and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality. RESULTS: Operative mortality was strongly influenced by surgical era (24% for 2000-2005 vs 12% for 2006-2010, P = 0.013). In multivariable logistic regression analysis, haemodynamic instability [odds ratio (OR) = 17.8, 95% confidence intervals (CIs) = 0.05-0.35, P <0.001], cardiopulmonary bypass time >200 min (OR = 9.5, 95% CI = 0.14-0.64, P = 0.002) and earlier date of surgery (OR = 5.8, 95% CI = 1.18-5.14, P = 0.016) emerged as independent predictors of operative mortality. Actuarial 5-year survival was worse for earlier compared with later date of surgery (64% for 2000-2005 vs 77% for 2006-2010, log-rank P <0.001). CONCLUSIONS: Surgical era significantly impacts early outcomes and actuarial survival following repair of acute type A aortic dissection.
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Conway et al. (2014) conducted a cohort in Acute type A aortic dissection (n=251). Earlier date of surgery (2000-2005) vs. Later date of surgery (2006-2010) was evaluated on Operative mortality (OR 5.8, 95% CI 1.18-5.14, p=0.016). Earlier date of surgery (2000-2005) for acute type A aortic dissection was an independent predictor of higher operative mortality compared to 2006-2010 (OR 5.8; 95% CI 1.18-5.14; P=0.016).
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