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J Thorac Cardiovasc Surg 2008;136:1172-1177
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Type A aortic dissection: Has surgical outcome improved with time?

Bristol Heart Institute, Bristol Royal Infirmary, Bristol, United Kingdom

Received for publication December 5, 2007; revisions received April 7, 2008; accepted for publication May 4, 2008.

^_* Address for reprints: Alan J. Bryan, FRCS (CTh), Consultant Cardiac Surgeon, Bristol Heart Institute, Bristol Royal Infirmary, Bristol, BS2 8HW, United Kingdom. (Email: Alan.Bryan{at}ubht.nhs.uk).

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.

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