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Ann Thorac Surg 2006;82:1658-1664
© 2006 The Society of Thoracic Surgeons

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Original Articles: Cardiovascular

Is Surgery Always Mandatory for Type A Aortic Dissection?

Cardiac Surgery Division, University of Turin, Turin, Italy

Accepted for publication May 15, 2006.

^_* Address correspondence to Dr Centofanti, S. Giovanni Battista Hospital, Cardiac Surgery Division, University of Turin, C.so Bramante 88, 10126 Turin, Italy (Email: paolocentofanti{at}tiscali.it).

Presented at the Forty-second Annual Meeting of The Society of Thoracic Surgeons, Chicago, IL, Jan 30–Feb 1, 2006.

BACKGROUND: The International Registry of Aortic Dissections showed that 42% of the unoperated patients with type A acute aortic dissection were discharged from the hospital after intensive medical treatment. We analyzed our experience to identify a preoperative score for in-hospital mortality to propose an alternative strategy for type A acute aortic dissection.

METHODS: From 1980 to 2004, 616 consecutive patients with type A acute aortic dissection underwent surgery in our center. The preoperative univariate risk factors with a probability value less than 0.05 were entered into multivariate analysis. A risk equation was developed: predicted mortality .

RESULTS: Early mortality was 25.1% (154 of 616 patients). Five risk factors were identified: age, coma, acute renal failure, shock, and redo operation. The ßi values are age 0.023, shock 0.771, reoperation 0.595, coma 1.162, acute renal failure 0.778; the constant (ß0) is –2.986.

CONCLUSIONS: Our large, single-center experience allowed us to develop a mathematical model to predict 30-day mortality for type A acute aortic dissection. When the expected mortality is 58% or less, surgery is always indicated. When the predicted mortality is greater than 58%, the possibility of survival is similar, according to International Registry of Aortic Dissections data, for surgery and medical treatment. In such cases surgery can no longer be considered mandatory, and a careful evaluation of the individual patient is recommended to choose the more suitable strategy.

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