Cirugía del síndrome aórtico agudo tipo A: seguimiento a 20 años

Abstract

Introduction and objectivesStanford type A acute aortic syndrome has an incidence of 3 cases/105 inhabitants/year, and has a mortality of 50% without treatment, and 17-31% after surgery.The purpose of this study is to analyse the predictive factors of in-hospital mortality, long-term survival, and reoperation in patients surgically operated on for type A acute aortic syndrome. MethodsBetween November 1996 and December 2017, 193 patients were intervened of which 75.5% were men. The median age was 63 years (range 17-85). High blood pressure (HBP) was observed in 51.6% had HBP, with 5.7% chronic obstructive pulmonary disease (COPD), 3.6% a previous intervention, 24.9% severe pericardial effusion, and 45.7% moderate-severe aortic insufficiency. ResultsIsolated replacement of ascending aorta was performed on 29.01%, associated to root replacement: 13.95%, to arch replacement in 44.55%, to root and arch replacement in 6.22%, and arch and descending aorta surgery “frozen elephant trunk “in 6.22%. Two (1.04%) patients died before starting extracorporeal circulation.Hospital mortality was 27.4%. Of the 12 personal backgrounds analysed, we found as mortality predictors the presence of HBP with an OR=2.2 (P=.017) and COPD OR=7.5 (P=.001).The mean follow-up time of the 140 survivors (11 lost patients) was 151±10 months. Survival at 1, 5, and 10 years was 94%, 82%, and 67%, respectively. Aortic rupture was the third cause of long-term death in the long-term, 16.13% (n=5).Neither severe aortic insufficiency nor the presence of residual dissection was predictive factors for reoperation. ConclusionsThis sample shows a hospital mortality rate similar to other studies, as well as good long-term survival. Close monitoring of the residual aorta is required to prevent its rupture.