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Ann Thorac Surg 2002;73:1843-1848
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Surgical treatment of acute type a dissection: is rupture a risk factor?

^a Departments of department of Cardiothoracic Surgery, University of Vienna, Vienna, Austria
^b Department of Cardiac Anesthesia, University of Vienna, Vienna, Austria
^c Department of Emergency Care, University of Vienna, Vienna, Austria

Accepted for publication February 17, 2002.

* Address reprint requests to Dr Ehrlich, Department of Cardiothoracic Surgery, University of Vienna, Währinger Gürtel 18-20, A-1090 Viennam, Austria
e-mail: marekehrlich{at}hotmail.com

Background. The purpose of this study was to evaluate the significance of aortic rupture on clinical outcome in patients after aortic repair for acute type A dissection.

Methods. One hundred and twenty patients underwent aortic operations with resection of the intimal tear and open distal anastomosis. Median age was 60 years (range 16 to 87); 78 were male. Thirty-six patients had only ascending aortic replacement, 82 had hemiarch repair, and 2 had the entire arch replaced. Retrograde cerebral perfusion was utilized in 66 patients (53%). Rupture defined as free blood in the pericardial space was present in 60 patients (50%). Univariate and multivariate analyses were performed to assess the risk factors for mortality and neurologic dysfunction.

Results. Overall hospital mortality rate was 24.2% ± 4.0% (± 70% confidence level) but did not differ between patients with aortic rupture or without (p = 0.83). The incidence of permanent neurologic dysfunction was 9.4% overall, 10.5% with rupture and 8.3% without rupture (p = 0.75). Multivariate analysis revealed absence of retrograde cerebral perfusion and any postoperative complication as statistically significant indicators for in-hospital mortality (p < 0.05). Overall 1- and 5-year survival was 85.3% and 33.7%; among discharged patients, survival in the nonruptured group was 89% and 37%, versus 81% and 31% in the ruptured group (p = 0.01).

Conclusions. Aortic rupture at the time of surgery does not increase the risk of hospital mortality or permanent neurologic complications in patients with acute type A dissections. However, aortic rupture at the time of surgery does influence long-term survival.

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