Surgical results in acute type A aortic dissection.

Currently international registry data present the patient mortality with acute type A aortic dissection managed non-surgically to be 58%, and managed surgically to be 26%. Many articles consistently report the hospital mortality exceeding 20% in western countries. Many factors, such as cardiac tamponade and dissection-related organ malperfusion, contribute to hospital mortality and morbidity. In Japan, the number of patients enrolled in the annual reports has been increasing and the surgical results have been improving year by year. In-hospital mortality has decreased to less than 20% since 1999. Since the beginning of our aortic program, a total of 98 patients underwent emergency operations, and the operative mortality and in-hospital mortality were 5.1% and 6.1%, respectively. In a recent series since 2001, the operative and in-hospital mortalities were remarkably low; 2.8% and 3.2% respectively. We were able to benefit greatly by various innovative technologies which include open distal anastomosis using hypothermic circulatory arrest with antegrade cerebral perfusion, gelatin-resorcin-formaldehyde (GRF) glue, branched presealed Dacron graft, and antegrade arterial perfusion. Our tear-oriented surgery could be justified in many patients in order to improve the surgical results. In patients with preoperative organ malperfusion, it is still challenging to improve the mortality and morbidity.