OBJECTIVE: The study objective was to determine whether developments in surgical, anesthetic, and perfusion techniques in the treatment of type A aortic dissection have resulted in improved clinical outcome. METHODS: A consecutive series of 165 patients undergoing surgical repair of type A aortic dissection performed between April of 1992 and March of 2006 in a single center were analyzed. Operations were grouped in 2 time frames of equal length (before April of 1999 vs from April of 1999 onward). RESULTS: There were 30 in-hospital deaths (18.2%), and the death rate was similar in the 2 time periods. Patients who underwent operation in the recent era compared with the earlier era were older (median 62 years [interquartile range 51-68] vs 59 years [45-68], P = .18), with a significantly higher incidence of concomitant coronary artery disease (13 [18%] vs 5 [7%], P = .03]) and significantly worse (moderate to poor) left ventricular function (33 [40%] vs 13 [18%], P = .002). The duration of circulatory arrest was shorter in the recent era (median 31 minutes [interquartile range 26.5-39] vs 37.5 minutes [31-45], P = .009), with a higher incidence of concomitant procedures (19 [21%] vs 10 [14%], P = .22). Except for total hospital stay, which increased over time, there were no significant differences in postoperative outcome. CONCLUSION: Despite the adoption of techniques to improve outcome for patients with type A dissection, mortality remains unchanged. A deteriorating risk profile and factors relating to the disease process itself may explain this observation.
|Translated title of the contribution||Type A aortic dissection: Has surgical outcome improved with time?|
|Pages (from-to)||1172 - 1177|
|Number of pages||6|
|Journal||Journal of Thoracic and Cardiovascular Surgery|
|Publication status||Published - Nov 2008|
Bibliographical noteOther: http://www.ncbi.nlm.nih.gov/pubmed/19026799?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum
- BTC (Bristol Trials Centre)