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.