Abstract
This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). Between January 2007 and June 2019, 603 consecutive patients underwent ATAAD repair at our institution. According to patients’ preoperative presentations and imaging studies, uncomplicated ATAAD was found in 276 (45.8%) patients by excluding preoperative complicated factors. Patients with uncomplicated ATAAD were classified into the survivor (n = 243) and non-survivor (n = 33) groups. Clinical features, surgical information, and postoperative complications were compared. Three-year survival and freedom from reoperation rates for survivors were analyzed using the Kaplan–Meier actuarial method. The in-hospital surgical mortality rate of uncomplicated ATAAD patients was 11.9%. The non-survivor group had a higher rate of postoperative malperfusion-related complications, and a multivariate analysis revealed that repeat surgery, retrograde cerebral perfusion, and intraoperative extracorporeal membrane oxygenation support were predictors of in-hospital mortality. In the survivor group, 3-year cumulative survival and freedom from aortic reoperation rates were 89.6% (95% confidence interval [CI] 84.8–92.9%) and 83.1% (95% CI 76.8–87.7%), respectively. In conclusion, uncomplicated and complicated ATAAD rates were similar; the short-term and mid-term surgical outcomes in patients with uncomplicated ATAAD were generally acceptable.
Highlights
This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD)
Acute type A aortic dissection (ATAAD) is a cardiovascular emergency associated with high morbidity and mortality rates
By excluding most of the preoperative complicated factors to obtain a study group of ATAAD patients with the lowest surgical risk, we generated a retrospective analysis of the experiences of an individual aortic surgery centre and aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated ATAAD
Summary
This retrospective study aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated acute type A aortic dissection (ATAAD). In previous studies, complicated preoperative conditions, such as the presence of hemodynamic instability, requirement for cardiopulmonary resuscitation (CPR), end-organ malperfusion, and haemopericardium with cardiac tamponade, were recognized as adverse factors for surgical outcomes of ATAAD p atients[1,2,3,4] Among these high-risk patients, the in-hospital mortality rates were reported to be 36–54%, which was approximately twice that of the majority of ATAAD population[5,6]. In another study reported by Piccardo et al, which was conduced with a more extended definition, patients without preoperative CPR, neurological deficit, and mesenteric ischemia were defined as uncomplicated[7] It only investigated the Cardiothoracic and Vascular Surgery, Chang-Gung Memorial Hospital, Linkou Medical Centre, 5 Fu‐Shing Street, Kwei‐Shan, Taoyuan 333, Taiwan. By excluding most of the preoperative complicated factors to obtain a study group of ATAAD patients with the lowest surgical risk, we generated a retrospective analysis of the experiences of an individual aortic surgery centre and aimed to clarify the short-term and mid-term outcomes of and prognostic factors for patients who underwent surgical repair for uncomplicated ATAAD
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