SURGICAL-MANAGEMENT OF AORTIC DISSECTION DURING A 30-YEAR PERIOD

Citation
Ji. Fann et al., SURGICAL-MANAGEMENT OF AORTIC DISSECTION DURING A 30-YEAR PERIOD, Circulation, 92(9), 1995, pp. 113-121
Citations number
28
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
113 - 121
Database
ISI
SICI code
0009-7322(1995)92:9<113:SOADDA>2.0.ZU;2-D
Abstract
Background Certain recent studies have demonstrated improved surgical outcome in patients with aortic dissection. We analyzed the surgical s urvival rates of patients with acute aortic dissections and the late p rognosis of those with aortic dissection during a 30-year period. Meth ods and Results Between 1963 and 1992, 360 patients (256 men and 104 w omen; mean+/-1 SD age, 57+/-14 years) underwent surgery for aortic dis section: 174 patients had an acute type A (AcA), 46 an acute type B (A cB), 106 a chronic type A (ChA), and 34 a chronic type B (ChB) aortic dissection. The overall operative mortality rate was 24+/-8% (26+/-3% for AcA, 39+/-8% for AcB, 17+/-4% for ChA, and 15+/-6% for ChB, [+/-70 % confidence limit]). The operative mortality rates for patients with acute aortic dissection (AcA or AcB) were assessed for five time ''win dows'': 1963 to 1972 (42+/-8%), 1973 to 1977 (37+/-8%), 1978 to 1982 ( 15+/-6%), 1983 to 1987 (27+/-6%), and 1988 to 1992 (26+/-6%). Logistic regression analysis suggested that the low operative mortality rate d uring the 1978-to-1982 interval occurred by chance. Multivariate analy sis showed earlier operative year, hypertension, cardiac tamponade, re nal dysfunction, and older age were independent determinants of operat ive death. Actuarial survival rates (including early deaths) after 5, 10, and 15 years for AcA patients were 55%, 37%, and 24%; for AcB, 48% , 29%, and 11%; for ChA, 65%, 45%, and 27%; and for ChB, 59%, 45%, and 27%. Multivariate analysis revealed that older age and previous opera tion were significant predictors for tate death. Freedom from reoperat ion for all patients was 84%, 67%, and 57% at 5, 10, and 15 years, res pectively. Conclusions Although the operative mortality rate decreased over time for patients with aortic dissection, the risk for those wit h acute aortic dissection during the last 10 years (1983 to 1992) is p robably more realistic than that observed in the preceding 5-year inte rval (1978 to 1982). The operative mortality rates for patients with c hronic aortic dissection have remained relatively static. Earlier diag nosis of acute aortic dissection before development of cardiac tampona de and renal impairment is critical to improve the operative salvage r ate. Long-term outcome still is not optimal, which emphasizes the need for better serial postoperative aortic imaging surveillance and medic al follow-up and blood pressure control.