Does conservative surgical approach improve early and late outcome in patients with acute type A aortic dissection?

Objective: Acute type A aortic dissection (AAAD) represents an emergency in cardiac surgery that requires immediate treatment to prevent death due to its fatal complications. The surgical approach is dependent on the involvement of AAAD. Methods: Sixty-one patients were operated for AAAD at our clinic. 48 (78.7%) were male and 13 (21.3%) were female with a mean age of 51+/-12.3 yr (range, 21-80 yr). Only the ascending aorta was replaced in 33 (54.1%) patients (Group I) and aortic arch replacement was included in 28 (45.9%) patients (Group II). The aortic valve was preserved in 43 (70.5%) patients (Group A) and replaced in 18 (29.5%) patients (Group B). Results: Early mortality rate was 23% (14/61). Multivariate analysis revealed that previous cardiac operations (P = 0.048). renal complications (P = 0.024), pump time (P = 0.024), and cardiac complications (P = 0.017) were significantly factors increasing early mortality. Late mortality rate was 8.5% (4/47) and multivariate analysis revealed that pulmonary complication (P = 0.015) was the only statistically significant independent risk factor. Arch replacement or aortic valve replacement was not a predictor for early or late mortality. Cumulative survival was 73.8+/-5.63% at 1 yr and 68.3+/-6.46% at 7.5 yr. Cumulative survival was not different between groups (P>0.05). Conclusions: Both radical and conservative surgical approaches in AAAD do not differ in mean of early or late results. Surgery before development of hemodynamic instability and prevention of other system complications improves the outcome of surgical treatment in AAAD. (C) 2002 The International Society for Cardiovascular Surgery. Published by Elsevier Science Ltd. All rights reserved.