Surgery for Type-A Aortic Dissection: 14-Year Contemporary Cohort Study

Abstract

Background: Type-A aortic dissection presents acutely with high mortality, and emergency surgery is generally recommended, acknowledging its significant risk. This study reviewed contemporary characteristics, trends and outcomes of surgery for type-A aortic dissection surgery at the current centre. Methods: Consecutive patients who underwent urgent surgery for type-A aortic dissection at Auckland City Hospital during March 2003-March 2017 were included, and relevant data were retrospectively collected for statistical analyses. Results: A total of 327 patients were studied and followed-up for a median of 3.3 years. The number of operations/year was steady at 11-20/year up to 2010, and increased thereafter to 23-40/year. Median age was 60.6 years, 124 (37.9%) were females, and 136 (41.6%) were Maori or Pacific ethnicity. Key characteristics included emergency surgery in 319 (97.6%), critical preoperative state in 62 (19.0%), malperfusion syndrome in 154 (47.1%), hypertension in 197 (60.2%), and previous cardiac surgery in 11 (3.4%). The aortic valve, coronary arteries, and mitral valve were also operated on in 64 (19.6%), 26 (8.0%), and three (0.9%) patients, respectively. Operative mortality occurred in 65 patients (19.9%) and composite morbidity in 212 (65.0%), predominantly: acute kidney injury in 134 (41.0%), ventilation >24 hours in 129 (39.6%), return to theatre in 94 (28.8%), and stroke in 63 (19.3%). Survival at 1, 5, and 10 years was 79.0%, 71.7%, and 57.8%, respectively. Critical preoperative state, malperfusion, and cross-clamp times were important predictors of mortality and composite morbidity. Conclusion: Surgery for acute type-A aortic dissection had high operative mortality and morbidities, although late mortality was low. Critical preoperative state and malperfusion syndrome were the key predictors of adverse outcomes.