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Ann Thorac Surg 2002;74:2034-2039
© 2002 The Society of Thoracic Surgeons
a Cardiovascular Surgery, Ege University Medical School, Izmir, Turkey
Accepted for publication July 22, 2002.
* Address reprint requests to Dr Apaydin, Department of Cardiovascular Surgery, Ege University Medical School, Bornova-Izmir, 35100 Turkey
e-mail: apaydina{at}efes.net.tr
BACKGROUND: This study was undertaken to identify the perioperative risk factors for death in patients with acute type A aortic dissection (AADA).
METHODS: Between 1993 and 2001, 108 consecutive patients (86 men; mean age, 53 years) underwent emergent operations for AADA. All patients but 2 underwent replacement of the ascending aorta with an open distal anastomosis during a period of hypothermic circulatory arrest. In addition, 22 patients had hemiarch and 5 had total arch replacement. Aortic root was replaced in 20 and repaired with gelatin-resorcinol-formaldehyde glue in 39 patients; aortic valve was separately replaced in 3, resuspended in 24, and remained untouched in 22 patients.
RESULTS: Overall in-hospital mortality was 25%. Mortality rate was significantly higher in patients with preoperative dissection complications than in those without (21/36 [58%] vs 6/72 [8%], p < 0.001). In multivariate analysis, predictors of mortality were presence of rupture, renal failure, and intestinal malperfusion, duration of cardiopulmonary bypass 
200 minutes, blood loss 500 mL, and transfusion of blood 4 units. Location of the intimal tear, extent of the replacement, type of the aortic root repair, and duration of hypothermic circulatory arrest did not emerge as predictors of mortality.
CONCLUSIONS: Major determinants of surgical mortality in patients with AADA are preoperative complications. Earlier diagnosis remains essential to improve the survival rate.
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