BACKGROUND:
Surgery for Stanford type A
aortic dissection shows a high operative mortality rate and frequent postoperative
brain injury. This study was designed to find out the
risk factors leading to operative
mortality and
brain injury after surgical repair in
patients with type A
aortic dissection. MATERIAL AND
METHOD:
One hundred and eleven
patients with type A
aortic dissection who underwent surgical repair between February, 1995 and January, 2005 were reviewed retrospectively. There were 99 acute
dissections and 12 chronic
dissections. Univariate and
multivariate analysis were performed to identify
risk factors of operative
mortality and
brain injury.
RESULT:
Hospital mortality occurred in 6
patients (5.4%). Permanent
neurologic deficit occurred in 8
patients (7.2%) and
transient neurologic deficit in 4 (3.6%). Overall 1, 5, 7 year
survival rate was 94.4, 86.3, and 81.5%, respectively. Univariate
analysis revealed 4
risk factors to be statistically significant as predictors of
mortality previous chronic type III
dissection,
emergency operation, intimal
tear in
aortic arch, and deep hypothemic circulatory arrest (DHCA) for more than 45 minutes.
Multivariate analysis revealed previous chronic type III
aortic dissection (
odds ratio (OR) 52.2), and DHCA for more than 45 minutes (OR 12.6) as
risk factors of operative
mortality. Pathological
obesity (OR 12.9) and total arch replacement (OR 8.5) were statistically significant
risk factors of
brain injury in
multivariate analysis.
CONCLUSION:
The result of surgical repair for Stanford type A
aortic dissection was good when we took into account the mortality rate, the
incidence of neurologic
injury, and the long-term
survival rate.
Surgery of type A
aortic dissection in
patients with a
history of chronic type III
dissection may increase the
risk of operative
mortality. Special care should be taken and efforts to reduce the hypothermic circulatory arrest
time should always be kept in mind.
Surgeons who are
planning to operate on
patients with pathological
obesity, or total arch replacement should be seriously consider for there is a higher
risk of
brain injury.