Surgical Treatment of Type A Aortic Dissection: Early-Term Results

Despite medical and technological improvement, acute type A aortic dissection is still a serious pathology, which causes death with any delay in early diagnosis. The aim of this study was to determine the early results of the surgical treatment of Stanford type A aortic dissection. 318 patients underwent surgical repair for intrathoracic aneurysm and/or dissection at Koşuyolu Heart and Research Hospital, between February 1985 and January 1999. Forty-eight (15.1%) of them were operated on for acute type A aortic dissection among whom 40 (83%) were male and 8 (17%) female with a mean age 49.9±11.1 years (range, 21 to 70). Only replacement of the ascending aorta (Group I) was performed at 24 (50%) patients and associated arch replacement (Group II) was performed at the other 24 (50%) patients. Aortic valve was preserved (Group A) in 35 (73%) patients and was replaced (Group B) in 13 (27%) patients. Surviving patients were followed up for 2.67±1.95 years (between 1 and 8). Early mortality was 22.9% (11 patients) and late mortality 4.2% (2 patients), total mortality rate being 27.1%. Univariate analysis showed that preoperative hemodynamic instability, coronary artery disease, extracorporeal circulation, renal complications, major neurologic and cardiac complications were statistically significant risk factors for early mortality. Forward stepwise logistic regression analysis showed that age, previous cardiac operation, extracorporeal circulation, renal and cardiac complications increased early mortality. There was no difference between groups for survival. Renal dysfunction, neurologic complications and rhythm problems were common morbidities. In Group A, aortic insufficiency regressed significantly after surgery (p<0.001). Surviving 31 patients had functional capacity in NYHA class I, and 4 had functional capacity in NYHA class II. Early surgical intervention for acute type A dissection decreases mortality rate because of the nature of the disease. It is important to determine predictors for early mortality. Sparing the aortic valve must be the first choice in all situations if possible. Flanged composite graft can be chosen when aortic root is included. TEE and CT must be performed annually for early diagnosis of late complications during follow-up.