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Heart and Vessels

, Volume 31, Issue 10, pp 1616–1624 | Cite as

Analysis of early and long-term outcomes of acute type A aortic dissection according to the new international aortic arch surgery study group recommendations

  • Andrea Colli
  • Massimiliano Carrozzini
  • Marco Galuppo
  • Marina Comisso
  • Francesca Toto
  • Dario Gregori
  • Gino Gerosa
Original Article

Abstract

To evaluate predictors of early and long-term outcomes of surgical repair of acute Type A aortic dissection. Retrospective single-centre study evaluating patients surgically treated between 1998 and 2013. Clinical follow-up was performed. Complications were classified according to the International Aortic Arch Surgery Study Group recommendations. Statistical analysis included univariate and multivariate analysis of preoperative and operative data. One hundred eighty-five patients were evaluated. The follow-up was complete for 180 patients (97 %). Mean age was 63 years, 82 % had a DeBakey type I aortic dissection, 18 % a type II. Eleven patients (6 %) died intraoperatively, 119 of the remaining (68 %) had postoperative complications. Thirty-day mortality was 21 % (38 patients). Average ICU and hospital stay were 6 and 14 days, respectively. During a mean follow-up time of 6 ± 4 years we observed 44 deaths (31 %). Twenty patients (14 %) needed late thoracic aorta reoperation. Results from the multivariate analysis are as follows. Thirty-day mortality was associated with abdominal pain at presentation (p < 0.01). The incidence of postoperative complications was related to older age at intervention (p < 0.01) and longer cross-clamp time (p < 0.01). Mortality at follow-up was significantly increased by older age at intervention (p < 0.01), with a logarithmic growth after 60 years, female sex (p < 0.01), preoperative limb ischemia (p = 0.02) and DHCA (p < 0.01). The surgical results of type A aortic dissection are affected by age at intervention with a logarithmic increase of late mortality in patients older than 60 years.

Keywords

Aortic dissection Aortic arch Cerebral protection Aortic operation Outcomes 

Notes

Compliance with ethical standards

Conflict of interest

None.

References

  1. 1.
    Golledge J, Eagle KA (2008) Acute aortic dissection. Lancet 372:55–66CrossRefPubMedGoogle Scholar
  2. 2.
    Braverman AC (2010) Acute aortic dissection: clinician update. Circulation 122:184–188CrossRefPubMedGoogle Scholar
  3. 3.
    Hagan PG, Nienaber CA, Isselbacher EM, Bruckman D, Karavite DJ, Russman PL, Evangelista A, Fattori R, Suzuki T, Oh JK, Moore AG, Malouf JF, Pape LA, Gaca C, Sechtem U, Lenferink S, Deutsch HJ, Diedrichs H, Marcos y Robles J, Llovet A, Gilon D, Das SK, Armstrong WF, Deeb GM, Eagle KA (2000) The international registry of acute aortic dissection (IRAD): new insights into an old disease. JAMA 283:897–903Google Scholar
  4. 4.
    Trimarchi S, Nienaber CA, Rampoldi V, Myrmel T, Suzuki T, Mehta RH, Bossone E, Cooper JV, Smith DE, Menicanti L, Frigiola A, Oh JK, Deeb MG, Isselbacher EM, Eagle KA, International Registry of Acute Aortic Dissection Investigators (2005) Contemporary results of surgery in acute type A aortic dissection: the international registry of acute aortic dissection experience. J Thorac Cardiovasc Surg 129:112–122CrossRefPubMedGoogle Scholar
  5. 5.
    Bekkers JA, Raap GB, Takkenberg JJ, Bogers AJ (2013) Acute type A aortic dissection: long-term results and reoperations. Eur J Cardiothorac Surg 43:389–396CrossRefPubMedGoogle Scholar
  6. 6.
    Haldenwang PL, Wahlers T, Himmels A, Wippermann J, Zeriouh M, Kroner A, Kuhr K, Strauch JT (2012) Evaluation of risk factors for transient neurological dysfunction and adverse outcome after repair of acute type A aortic dissection in 122 consecutive patients. Eur J Cardiothorac Surg 42:e115–e120CrossRefPubMedGoogle Scholar
  7. 7.
    Chiappini B, Schepens M, Tan E, Dell’Amore A, Morshuis W, Dossche K, Bergonzini M, Camurri N, Reggiani LB, Marinelli G, Di Bartolomeo R (2005) Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients. Eur Heart J 26:180–186CrossRefPubMedGoogle Scholar
  8. 8.
    Mehta RH, Suzuki T, Hagan PG, Bossone E, Gilon D, Llovet A, Maroto LC, Cooper JV, Smith DE, Armstrong WF, Nienaber CA, Eagle KA, International Registry of Acute Aortic Dissection (IRAD) Investigators (2002) Predicting death in patients with acute type A aortic dissection. Circulation 105:200–206CrossRefPubMedGoogle Scholar
  9. 9.
    Ehrlich M, Fang WC, Grabenwoger M, Cartes-Zumelzu F, Wolner E, Havel M (1998) Perioperative risk factors for mortality in patients with acute type A aortic dissection. Circulation 98:294–298CrossRefGoogle Scholar
  10. 10.
    Pansini S, Gagliardotto PV, Pompei E, Parisi F, Bardi G, Castenetto E, Orzan F, di Summa M (1998) Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg 66:779–784CrossRefPubMedGoogle Scholar
  11. 11.
    Bonser RS, Ranasinghe AM, Loubani M, Evans JD, Thalji NM, Bachet JE, Carrel TP, Czerny M, Di Bartolomeo R, Grabenwoger M, Lonn L, Mestres CA, Schepens MA, Weigang E (2011) Evidence, lack of evidence, controversy, and debate in the provision and performance of the surgery of acute type A aortic dissection. J Am Coll Cardiol 58:2455–2474CrossRefPubMedGoogle Scholar
  12. 12.
    Daily PO, Trueblood HW, Stinson EB, Wuerflein RD, Shumway NE (1970) Management of acute aortic dissections. Ann Thorac Surg 10:237–247CrossRefPubMedGoogle Scholar
  13. 13.
    DeBakey ME, Cooley DA, Creech O Jr (1955) Surgical considerations of dissecting aneurysm of the aorta. Ann Surg 142:586–610CrossRefGoogle Scholar
  14. 14.
    Tsai TT, Nienaber CA, Eagle KA (2005) Acute aortic syndromes. Circulation 112:3802–3813CrossRefPubMedGoogle Scholar
  15. 15.
    Erbel R, Aboyans V, Boileau C, Bossone E, Di Bartolomeo R, Eggebrecht H, Evangelista A, Falk V, Frank H, Gaemperli O, Grabenwoger M, Haverich A, Iung B, Manolis AJ, Meijboom F, Nienaber CA, Roffi M, Rousseau H, Sechtem U, Sirnes PA, von Allmen RS, Vrints CJ, Authors/Task Force members (2014) 2014 ESC guidelines on the diagnosis and treatment of aortic diseases: document covering acute and chronic aortic diseases of the thoracic and abdominal aorta of the adult. The task force for the diagnosis and treatment of aortic diseases of the european society of cardiology (ESC). Eur Heart J 35(41):2873–2926CrossRefPubMedGoogle Scholar
  16. 16.
    Yan TD, Tian DH, Lemaire SA, Hughes GC, Chen EP, Misfeld M, Griepp RB, Kazui T, Bannon PG, Coselli JS, Elefteriades JA, Kouchoukos NT, Underwood MJ, Mathew JP, Mohr FW, Oo A, Sundt TM, Bavaria JE, Di Bartolomeo R, Di Eusanio M, Trimarchi S, International Aortic Arch Surgery Study Group (2014) Standardizing clinical end points in aortic arch surgery: a consensus statement from the international aortic arch surgery study group. Circulation 129:1610–1626CrossRefPubMedGoogle Scholar
  17. 17.
    Kazui T, Inoue N, Yamada O, Komatsu S (1992) Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment. Ann Thorac Surg 53:109–114CrossRefPubMedGoogle Scholar
  18. 18.
    Kilic A, Tang R, Whitson BA, Sirak JH, Sai-Sudhakar CB, Crestanello J, Higgins RS (2013) Outcomes in the current surgical era following operative repair of acute type A aortic dissection in the elderly: a single-institutional experience. Interact CardioVasc Thorac Surg 17:104–109CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Russo CF, Mariscalco G, Colli A, Santè P, Nicolini F, Miceli A, De Chiara B, Beghi C, Gerosa G, Glauber M, Gherli T, Nappi G, Murzi M, Molardi A, Merlanti B, Vizzardi E, Banadei I, Coletti G, Carrozzini M, Gelsomino S, Caiazzo A, Lorusso R (2015) Italian multicentre study on type A acute aortic dissection: a 33-year follow-up. Eur J Cardiothorac Surg. doi: 10.1093/ejcts/ezv048 PubMedGoogle Scholar
  20. 20.
    Ohnuma T, Kimura N, Sasabuchi Y, Asaka K, ShiotsukaJ Komuro T, Mouri H, Lefor AT, Adachi H, Sanui M (2015) Lower heart rate in the early postoperative period does not correlate with long-term outcomes after repair of type A acute aortic dissection. Heart Vessels 30(3):355–361CrossRefPubMedGoogle Scholar
  21. 21.
    Schneider SRB, Dell’Aquila AM, Akil A, Schlarb D, Panuccio G, Martens S, Rukosujew A (2014) Results of “elephant trunk” total aortic arch replacement using a multi-branched, collared graft prosthesis. Heart vessels. doi: 10.1007/s00380-014-0612-6 PubMedGoogle Scholar
  22. 22.
    Rampoldi V, Trimarchi S, Eagle KA, Nienaber CA, Oh JK, Bossone E, Myrmel T, Sangiorgi GM, De Vincentiis C, Cooper JV, Fang J, Smith D, Tsai T, Raghupathy A, Fattori R, Sechtem U, Deeb MG, Sundt TM 3rd, Isselbacher EM, International Registry of Acute Aortic Dissection (IRAD) Investigators (2007) Simple risk models to predict surgical mortality in acute type A aortic dissection: The international registry of acute aortic dissection score. Ann Thorac Surg 83:55–61CrossRefPubMedGoogle Scholar
  23. 23.
    Tan ME, Dossche KM, Morshuis WJ, Knaepen PJ, Defauw JJ, van Swieten HA, van Boven WJ, Kelder JC, Waanders FG, Schepens MA (2003) Operative risk factors of type A aortic dissection: analysis of 252 consecutive patients. Cardiovasc Surg 11:277–285CrossRefPubMedGoogle Scholar
  24. 24.
    Geirsson A, Szeto WY, Pochettivo A, McGarvey ML, Keane MG, Woo YJ, Augoustides JG, Bavaria JE (2007) Significance of malperfusion syndromes prior to contemporary surgical repair for acute type A dissection: outcomes and need for additional revascularizations. Eur J Cardiothorac Surg 32(2):255–262CrossRefPubMedGoogle Scholar
  25. 25.
    Chou HT, Lo JP, Chua CH, Lu MJ, Lin CH (2015) Initial Experience of modified four-branched graft technique and antegrade TEVAR in acute type A aortic dissection. Ann Thorac Cardiovasc Surg. doi: 10.5761/atcs.oa.15-00015 PubMedPubMedCentralGoogle Scholar
  26. 26.
    Sacks D, McClenny TE, Cardella JF, Lewis CA (2003) Society of Interventional Radiology clinical practice guidelines. J Vasc Interv Radiol 14(9):S199–S202CrossRefPubMedGoogle Scholar
  27. 27.
    Midulla M, Renaud A, Martinelli T, Koussa M, Mounier-Vehier C, Prat A, Beregi JP (2011) Endovascular fenestration in aortic dissection with acute malperfusion syndrome: immediate and late follow-up. J Thorac Cardiovasc Surg 142:66–72CrossRefPubMedGoogle Scholar
  28. 28.
    Beregi JP, Haulon S, Otal P, Thony F, Bartoli JM, Crochet D, Lacombe P, Bonneville JF, Besse F, Douek P, Heautot JF, Rousseau H, Societé Fraçaise d’Imagerie Cardio-Vasculaire (SFICV) Research Group on Aortic Dissection (2003) Endovascular treatment of acute complications associated with aortic dissection: midterm results from a multicenter study. J Endovasc Ther 10:486–493CrossRefPubMedGoogle Scholar
  29. 29.
    Patel HJ, Williams DM, Meerkov M, Dasika NL, Upchurch GR, Deeb GM (2009) long-term results of percutaneous management of malperfusion in acute type B aortic dissection: implications for thoracic aortic endovascular repair. J Thorac Cardiovasc Surg 138:300–308CrossRefPubMedGoogle Scholar
  30. 30.
    Slonim SM, Miller DC, Mitchell RS, Semba CP, Razavi MK, Dake MD (1999) percutaneous balloon fenestration and stenting for life-threatening ischemic complications in patients with acute aortic dissection. J Thorac Cardiovasc Surg 117:1118–1126CrossRefPubMedGoogle Scholar
  31. 31.
    Neri E, Toscano T, Massetti M, Capannini G, Carone E, Tucci E, Diciolla F, Scolletta S, Morello R, Sassi C (2001) Operation for acute type A aortic dissection in octogenarians: is it justified? J Thorac Cardiovasc Surg 121:259–267CrossRefPubMedGoogle Scholar
  32. 32.
    Mehta RH, O’Gara PT, Bossone E, Nienaber CA, Myrmel T, Cooper JV, Smith DE, Armstrong WF, Isselbacher EM, Pape LA, Eagle KA, Gilon D, International Registry of Acute Aortic Dissection (IRAD) Investigators (2002) Acute type A aortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 40:685–692CrossRefPubMedGoogle Scholar
  33. 33.
    Trimarchi S, Eagle KA, Nienaber CA, Rampoldi V, Jonker FH, De Vincentiis C, Frigiola A, Menicanti L, Tsai T, Froehlich J, Evangelista A, Montgomery D, Bossone E, Cooper JV, Li J, Deeb MG, Meinhardt G, Sundt TM, Isselbacher EM, International Registry of Acute Aortic Dissection Investigators (2010) Role of age in acute type A aortic dissection outcome: report from the international registry of acute aortic dissection (IRAD). J Thorac Cardiovasc Surg 140:784–789CrossRefPubMedGoogle Scholar
  34. 34.
    Rylski B, Suedkamp M, Beyersdorf F, Nitsch B, Hoffmann I, Blettner M, Weigang E (2011) Outcome after surgery for acute aortic dissection type A in patients over 70 years: data analysis from the german registry for acute aortic dissection type A (GERAADA). Eur J Cardiothorac Surg 40:435–440PubMedGoogle Scholar
  35. 35.
    Tang GH, Malekan R, Yu CJ, Kai M, Lansman SL, Spielvogel D (2013) Surgery for acute type A aortic dissection in octogenarians is justified. J Thorac Cardiovasc Surg 145:S186–S190CrossRefPubMedGoogle Scholar

Copyright information

© Springer Japan 2015

Authors and Affiliations

  • Andrea Colli
    • 1
  • Massimiliano Carrozzini
    • 1
  • Marco Galuppo
    • 1
  • Marina Comisso
    • 1
  • Francesca Toto
    • 1
  • Dario Gregori
    • 2
  • Gino Gerosa
    • 1
  1. 1.Cardiac Surgery Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly
  2. 2.Biostatistics, Epidemiology and Public Health Unit, Department of Cardiac, Thoracic and Vascular SciencesUniversity of PaduaPaduaItaly

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