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DOI: 10.1055/s-0032-1332541
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.
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.