Early and late survival of repaired type A aortic dissection

Abstract

From 1 January 1977 to 31 December 1988, 119 patients were operated upon for type A aortic dissection. The maximum follow-up was 11.7 years (median 5.6 years); follow-up was 100% complete. Actuarial survival was 47.3% +/- 5%. The death risk decreased rapidly to a constant rate of 0.0027 events/month after 3 months. There were 41 early deaths, mostly due to haemorrhage, brain damage and low output syndrome. A significantly higher probability of early death was observed in patients with preoperative myocardial ischaemia or infarction (P less than 0.0001) or preoperative cerebral symptoms (P = 0.0002). Extended dissection increased the risk proportionally to the length of the aorta involved (P = 0.0002). Typical dissection originating from an intimal tear in the ascending aorta had a significantly lower operative risk than atypical dissection with an intimal tear not localized in the aortic root (P = 0.0006). Of the 14 late deaths, 2 were unrelated to dissection, 2 were of unknown origin and 4 were sudden. Stroke was the cause of 2 and congestive heart failure the cause of 4 deaths. The probability of late death was higher in patients with perioperative brain damage (P = 0.003) and in patients with preoperative shock (P = 0.0025). It was significantly lower in patients with dissection of hypertensive aetiology (P = 0.002). There were 13 reoperations on 12 patients. Early reoperations were due to rupture of the distal aortic anastomosis. Late reoperations were mostly due to dehiscence of aortic valvular prosthesis.(ABSTRACT TRUNCATED AT 250 WORDS)

Nonsurgical Reconstruction of Thoracic Aortic Dissection by Stent–Graft Placement

“…8,9,19 Except for catheter fenes-tration of occlusive distal flaps, no interventions have proved useful for managing aortic dissection. 20,21 Whereas emergency surgical repair is lifesaving in ascending (type A) aortic dissection, [1][2][3][4]22 both emergency surgery and deferred surgery for descending (type B) dissection are associated with a 6 to 67 percent mortality rate, depending on the patient group assessed, and neither offers a substantial advantage over medical therapy. 1,6,9,14,[23][24][25][26] Also, paraplegia (or paresis) occurs in 7 to 36 percent of patients who undergo surgery, depending on the extent of aortic resection and the duration of cross-clamping.…”

Early and Late Results of Ascending Aorta Surgery: Risk Factors for Early and Late Outcome

“…Patients who undergo ascending aorta surgery are a miscellaneous group depending on pathology, priority of surgery, in-hospital mortality, and late survival expectancy [1][2][3][4][5][6][7][8]. In addition, the predictors of in-hospital results frequently do not coincide with the determinants of long-term survival [2, 3, 9 -11].…”

Rizikos veiksnių įtaka ligonių išgyvenimui po kylančiosios aortos aneurizmos korekcijos konduitu

“…Nagrinëjant reikðmingø rizikos veiksniø átakà ligoniø iðgyvenimui, prieita prie iðvados, kad gauti duomenys sutampa su daugelio autoriø duomenimis [6][7][8][9]. Literatûroje rasta nedaug straipsniø apie reikðmingø rizikos veiksniø átakà klinikinei eigai.…”