Abstract
The goal of this study was to compare operative mortality and actuarial survival between patients presenting with and without hemodynamic instability who underwent repair of acute Type A aortic dissection. Previous studies have demonstrated that hemodynamic instability is related to differences in early and late outcomes following acute Type A dissection occurrence. However, it is unknown whether hemodynamic instability at the initial presentation affects early clinical outcomes and survival after repair of Type A aortic dissection. A total of 251 patients from four academic medical centers underwent repair of acute Type A aortic dissection between January 2000 and October 2010. Of those, 30 presented with hemodynamic instability while 221 patients did not. Median ages were 63 years (range 38-82) and 60 years (range 19-87) for patients presenting with hemodynamic instability compared to patients without hemodynamic instability, respectively (P = 0.595). Major morbidity, operative mortality, and 10-year actuarial survival were compared between groups. Operative mortality was profoundly influenced by hemodynamic instability (patients with hemodynamic instability 47% versus 14% for patients without hemodynamic instability, P < 0.001). Actuarial 10-year survival rates for patients with hemodynamic instability were 44% versus 63% for patients without hemodynamic instability (P = 0.007). Hemodynamic instability has a profoundly negative impact on early outcomes and operative mortality in patients with acute Type A aortic dissection. However, late survival is comparable between hemodynamically unstable and non-hemodynamically unstable patients.
Highlights
Acute Type A aortic dissection exists as a medical crisis with heightened mortality attributable to an increased risk of aortic rupture or malperfusion [1,2,3,4,5,6,7,8,9,10]
Previous studies have demonstrated that hemodynamic instability is related to differences in early and late outcomes following acute Type A dissection occurrence
There is a paucity of studies investigating the effect of hemodynamic instability on early clinical outcomes and late survival, as well as the importance of surgical decision making in patients with acute Type A aortic dissection
Summary
Acute Type A aortic dissection exists as a medical crisis with heightened mortality attributable to an increased risk of aortic rupture or malperfusion [1,2,3,4,5,6,7,8,9,10]. Our study sought to evaluate whether patients presenting with hemodynamic instability have worse early clinical outcomes and late actuarial survival following repair of acute Type A aortic dissection compared to patients presenting without hemodynamic instability. The goal of this study was to compare operative mortality and actuarial survival between patients presenting with and without hemodynamic instability who underwent repair of acute Type A aortic dissection. Previous studies have demonstrated that hemodynamic instability is related to differences in early and late outcomes following acute Type A dissection occurrence. It is unknown whether hemodynamic instability at the initial presentation affects early clinical outcomes and survival after repair of Type A aortic dissection. Results: Operative mortality was profoundly influenced by hemodynamic instability
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