Malperfusion rather than merely timing of operative repair determines early and late outcome in type A aortic dissection

Pradeep Narayan, Chris A. Rogers, Umberto Benedetto, Massimo Caputo, Gianni D. Angelini, Alan J. Bryan*

*Corresponding author for this work

Research output: Contribution to journalArticle (Academic Journal)

10 Citations (Scopus)
233 Downloads (Pure)

Abstract

Background Although generally better outcomes are reported in patients undergoing early repair of type A aortic dissection, patients who survive the first 48 hours self-select themselves toward better outcomes as well. Malperfusion is another important determinant of outcome in these patients. The aim of this study was to examine the hypothesis that malperfusion, not the timing of operation, is the dominant determinant of outcome in repair of type A aortic dissection. Methods A total of 205 patients underwent operative repair of acute type A aortic dissection in our hospital over a 17-year period. The time from symptom onset to surgical repair was reliably established in 152 cases. Patients were grouped into those who had undergone surgery within 12 hours of symptom onset (early surgery group; n = 72 [47%]) and those who underwent surgery beyond 12 hours of symptom onset (late surgery group; n = 80 [53%]). Results Thirty-day mortality was similar in the 2 groups (early surgery: 19.4% [95% confidence interval [CI] 12.0%-30.6%]; late surgery: 13.8% [95% CI, 7.9%-23.5%]; P =.08). The log-rank test for equality of survivor functions was 0.08. However, malperfusion with hemodynamic compromise was more common in the early surgery group (47% vs 31%; P =.029) and was identified as an independent predictor of long-term mortality (hazard ratio, 2.65; 95% CI, 1.21-5.79; P =.014). Conclusions Malperfusion at presentation rather than timing of intervention is the major risk factor of death both in the hospital and at long-term follow-up in patients undergoing surgery for type A aortic dissection.

Original languageEnglish
Pages (from-to)81-86
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume154
Issue number1
Early online date21 Mar 2017
DOIs
Publication statusPublished - Jul 2017

Structured keywords

  • Centre for Surgical Research
  • BTC (Bristol Trials Centre)

Keywords

  • Aortic and arterial disease
  • Aortic dissection or intramural hematoma
  • Aortic surgery

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