ORIGINAL ARTICLE  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2021 August;62(4):377-84

DOI: 10.23736/S0021-9509.21.11607-6

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A decade of surgical therapy in an all-comer cohort with type A aortic dissection

Jing LI ¹ ✉, Matthaeus ZERDZITZKI ¹, Daniele CAMBONI ¹, Bernhard FLOERCHINGER ¹, Christoph UNTERBUCHNER ², Christof SCHMID ¹, Leopold RUPPRECHT ¹

¹ Department of Cardiothoracic Surgery, University Medical Center of Regensburg, Regensburg, Germany; ² Department of Anesthesiology, University Medical Center of Regensburg, Regensburg, Germany

BACKGROUND: We reported on a decade of aortic surgery for type A aortic dissection to assess surgical techniques employed and outcomes over time in an all-comer analysis of a mid-size university cardiosurgical center.
METHODS: From 2009 to 2018, 283 patients (189 males and 94 females, mean age 62 years, range 30-85 years), who underwent surgical therapy for type A aortic dissection in our institution were included in a retrospective statistical analysis.
RESULTS: Among all the patients, 55.5% of them were hemodynamically stable, 10.3% came in intubated. A neurological deficit was present in 18.9% of cases, extremity malperfusion was noted in 17.4%, and abdominal malperfusion detected in 8.2%. The extent of the aortic dissection corresponded to DeBakey type I in 88% of cases, a thoracoabdominal involvement was seen in 64%. In 51.9% of patients, only the ascending aorta replaced, another 40.6% of patients had proximal arch replacement too. A separate stent placement into the descending aorta was achieved in 13.4% of patients, during surgery (5.7%) or thereafter (7.7%). Overall survival to discharge was 79.5%. Most frequent complications were stroke and paralysis (15.2%), but only visceral malperfusion (OR 9.0) and heart failure mandating ECMO therapy (OR 29.5) were associated with significantly increased mortality.
CONCLUSIONS: Surgery for type A aortic dissection is still challenging. Along with the refinement of surgical techniques, the indication for the various procedures has moved from a simplified general strategy to a more individualized concept.

KEY WORDS: Aneurysm, dissecting; Stents; Surgical procedures, operative