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Eur Heart J. 2005 Jan;26(2):180-6. Epub 2004 Dec 7.

Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients.

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1
Department of Cardiovascular Surgery, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy. bruno_chiappini@hotmail.com

Abstract

AIMS:

The purpose of this retrospective study was to assess the risk factors for the early and late outcome of the surgical treatment of acute type A aortic dissection, in terms of mortality and morbidity.

METHODS AND RESULTS:

From 1976 to 2003, 487 patients with acute type A aortic dissection treated surgically were enrolled. Twenty-five pre-operative and intra-operative variables were analysed to identify conditions influencing early and late morbidity and early mortality. The in-hospital mortality rate including operative death was 22% (107 patients). Multivariable analysis indicated that pre-existing cardiac disease (RR=3.7, 95% CI=1.8-7.4) and cardiopulmonary resuscitation (RR=6.8, 95% CI=2.3-20.2) were independent predictors of in-hospital death. The causes of in-hospital mortality were low cardiac output in 32 patients (6.6%), major brain damage in 24 patients (5.9%), haemorrhage in 11 patients (2.2%), sepsis in nine patients (1.8%), visceral ischaemia in eight patients (1.6%), multiple organ failure in seven patients (1.4%), rupture of the thoracic aorta in six patients (1.2%), respiratory failure in six patients (1.2%), and four intra-operative deaths. The follow-up was 100% complete. The actuarial survival was 94.9+/-1.2% and 88.1+/-2.6%, at 5 and 10 years, respectively.

CONCLUSIONS:

Patients' pre-operative co-morbidities and dissection-related complications significantly affect early and late survival and morbidity after surgical treatment of acute type A aortic dissection.

PMID:
15618075
DOI:
10.1093/eurheartj/ehi024
[Indexed for MEDLINE]
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