• Interact Cardiovasc Thorac Surg · Dec 2014

    Multicenter Study Comparative Study

    Improved clinical outcomes and survival following repair of acute type A aortic dissection in the current era.

    • Brian D Conway, Sotiris C Stamou, Nicholas T Kouchoukos, Kevin W Lobdell, Kamal R Khabbaz, Edward Murphy, and Robert C Hagberg.
    • Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, USA.
    • Interact Cardiovasc Thorac Surg. 2014 Dec 1; 19 (6): 971-6.

    ObjectivesThe goal of this study was to compare early postoperative outcomes and actuarial-free survival between patients who underwent repair of acute type A aortic dissection during 2000-2005 and 2006-2010.MethodsA total of 251 patients from four academic medical centres underwent repair of acute type A aortic dissection between January 2000 and October 2010. Of those, 111 patients underwent repair during 2000-2005, whereas 140 patients underwent repair during 2006-2010. Median ages were 62 years (range 20-83) and 58 years (range 30-80) for patients repaired from 2000-2005 compared with those repaired during 2006-2010, respectively (P = 0.180). Major morbidity, operative mortality and 5-year actuarial survival were compared between groups. Multivariate logistic regression was used to determine predictors of operative mortality.ResultsOperative mortality was strongly influenced by surgical era (24% for 2000-2005 vs 12% for 2006-2010, P = 0.013). In multivariable logistic regression analysis, haemodynamic instability [odds ratio (OR) = 17.8, 95% confidence intervals (CIs) = 0.05-0.35, P <0.001], cardiopulmonary bypass time >200 min (OR = 9.5, 95% CI = 0.14-0.64, P = 0.002) and earlier date of surgery (OR = 5.8, 95% CI = 1.18-5.14, P = 0.016) emerged as independent predictors of operative mortality. Actuarial 5-year survival was worse for earlier compared with later date of surgery (64% for 2000-2005 vs 77% for 2006-2010, log-rank P <0.001).ConclusionsSurgical era significantly impacts early outcomes and actuarial survival following repair of acute type A aortic dissection.© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

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