Tom Kai Ming Wang1, Danting Wei2, Thomas Evans3, Tharumenthiran Ramanathan3, David Haydock3. 1. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Cardiology, Middlemore Hospital, Auckland, New Zealand. Electronic address: TWang@adhb.govt.nz. 2. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand; Department of Cardiology, Middlemore Hospital, Auckland, New Zealand. 3. Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand.
Abstract
BACKGROUND: Type A aortic dissection is a fatal condition warranting emergency surgery to prevent complications and death. We reviewed the contemporary trends, characteristics, outcomes and predictors of this operation at our centre over a 14-year period. METHODS: Consecutive patients undergoing type A aortic dissection surgery at Auckland City Hospital during March 2003-March 2017 were studied, and relevant characteristics and outcomes collected prospectively for statistical analyses. RESULTS: There were 327 patients included, and the number of operations each year remained similar from 2003-2010, and steadily increased thereafter. Median age was 60.6 years, with 124 (37.9%) females, 136 (41.6%) Maori or Pacific ethnicity, 319 (97.6%) emergency surgeries, 62 (19.0%) in a critical preoperative state and 154 (47.1%) having a malperfusion syndrome. Operative mortality occurred in 65 (19.9%), although this has decreased from 23.3% before 2014 to 14.0% since. Composite morbidity occurred in 212 (65.0%), predominantly acute kidney injury 134 (41.0%), ventilation >24 hours (129 (39.6%), return to theatre 94 (28.8%) and stroke 63 (19.3%). Survival at 1, 5 and 10 years was 79.0%, 71.7% and 57.8% respectively. Critical preoperative state and malperfusion syndrome were independent predictors of operative and long-term mortality and composite morbidity. CONCLUSION: Surgery for acute type A aortic dissection has been increasing since 2011 and continues to have high rates of operative mortality and morbidities, although the former has decreased since 2014. Critical preoperative state and malperfusion were the key predictors of adverse outcomes. After surviving the perioperative period, prognosis was good with low rates of late mortality.
BACKGROUND: Type A aortic dissection is a fatal condition warranting emergency surgery to prevent complications and death. We reviewed the contemporary trends, characteristics, outcomes and predictors of this operation at our centre over a 14-year period. METHODS: Consecutive patients undergoing type A aortic dissection surgery at Auckland City Hospital during March 2003-March 2017 were studied, and relevant characteristics and outcomes collected prospectively for statistical analyses. RESULTS: There were 327 patients included, and the number of operations each year remained similar from 2003-2010, and steadily increased thereafter. Median age was 60.6 years, with 124 (37.9%) females, 136 (41.6%) Maori or Pacific ethnicity, 319 (97.6%) emergency surgeries, 62 (19.0%) in a critical preoperative state and 154 (47.1%) having a malperfusion syndrome. Operative mortality occurred in 65 (19.9%), although this has decreased from 23.3% before 2014 to 14.0% since. Composite morbidity occurred in 212 (65.0%), predominantly acute kidney injury 134 (41.0%), ventilation >24 hours (129 (39.6%), return to theatre 94 (28.8%) and stroke 63 (19.3%). Survival at 1, 5 and 10 years was 79.0%, 71.7% and 57.8% respectively. Critical preoperative state and malperfusion syndrome were independent predictors of operative and long-term mortality and composite morbidity. CONCLUSION: Surgery for acute type A aortic dissection has been increasing since 2011 and continues to have high rates of operative mortality and morbidities, although the former has decreased since 2014. Critical preoperative state and malperfusion were the key predictors of adverse outcomes. After surviving the perioperative period, prognosis was good with low rates of late mortality.
Authors: Paolo Nardi; Carlo Bassano; Calogera Pisano; Claudia Altieri; Maria Sabrina Ferrante; Monica Greci; Dario Buioni; Fabio Bertoldo; Andrea Farinaccio; Giovanni Ruvolo Journal: Kardiochir Torakochirurgia Pol Date: 2021-05-15