Surgical treatment of acute type A dissections in profound hypothermic circulatory arrest

This study was designed to explore the perioperative risk factors for mortality in 124 patients operated on for acute type A aortic dissection. Their average age was 57 years (range 16-87 years); 88 were male. Altogether, 32 patients had only ascending aortic replacement, 81 had a hemi-arch repair, in 9 the entire arch was replaced, and in 2 replacement included the proximal descending aorta. Retrograde cerebral perfusion (RCP) was used in 47.5% (59/124) of the patients in addition to hypothermic cardiac arrest (HCA). The 30-day mortality rate for all patients was 28% (35/124). Univariate analysis revealed four pre- and intraoperative risk factors that were statistically significant predictors for mortality: previous cardiac operations, preoperative hemodynamic instability, preoperative cardiopulmonary resuscitation, and lack of RCP (P < 0.05). Rupture of the aneurysm and HCA time were not found to be risk factors for mortality. Stepwise multiple logistic regression confirmed that preoperative hemodynamic instability and lack of RCP were statistically significant independent risk factors for mortality (P < 0.05). Univariate analysis revealed five postoperative complications that were statistically significant predictors for mortality: liver failure, myocardial infarction, stroke, sepsis, and pulmonary dysfunction (P < 0.05). Early operation in a stable hemodynamic condition and the use of RCP can decrease the risk of operative mortality.