Predictors for long-term survival in patients with acute type A aortic dissection

Objective: This study evaluates the preoperative predictors influencing the long-term survival of patients undergoing surgery for acute type A aortic dissection (ATAAD). Methods: Between January 2000 and August 2011, 164 consecutive patients (mean age 61.4 ± 12.7) with ATAAD underwent replacement of the ascending aorta using a dacron graft including hemi arch in 97 (59.1%) and total arch in 17 (10.4%) patients. Of these, 77.4% (n = 127) underwent supracoronary aortic replacement and 22.6% (n = 37) underwent root replacement (Bentall and valve-sparing procedures). We retrospectively analyzed 21 pre-operative variables such as vigilance, malperfusion, neurology, critical status (CPR, inotropic support, intubation), etiology, and risk factors for cardiovascular disease of the total cohort using Kaplan-Meier method and Cox regression. Results: The 30-day mortality rate was 17.7% (29/164 patients). Hospital stay was 11.3 days (range 1 – 41 days). Actuarial survival at 1, 5 and 10 years was 74.5%, 58.5%, and 41.5% respectively. The statistical significant predictors are summarized in table 1. Table 1: Predictors for poor long-term survival Preoperativ Predictors/Risk Factors P value Odds Ratio (OR) Critical Preoperative State (CPS) 0.021 0.51 Iatrogenic origin dissection, e.g. catheter, operation 0.003 0.10 Pre-operative Vigilance, Unconscious 0.003 6.24 Pre-operative Vigilance, sedated 0.008 2.28 Pre-operative Malperfusion, visceral/coronar 0.008 3.55 Pre-operative Malperfusion cerebral/spinal 0.011 3.17 Diabetes mellitus 0.048 0.06 Conclusion: This study shows that the compromising factors for impaired long-term survival are malperfusion, iatrogenic dissection, unconsciousness and hemodynamic instability, whereas connective tissue disease did not affect long-term survival. Also diabetes mellitus seems to be connected with a poor long-term prognosis after ATAAD.