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European Heart Journal Advance Access originally published online on December 7, 2004
European Heart Journal 2005 26(2):180-186; doi:10.1093/eurheartj/ehi024
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European Heart Journal vol. 26 no. 2 © The European Society of Cardiology 2004; all rights reserved.

Early and late outcomes of acute type A aortic dissection: analysis of risk factors in 487 consecutive patients

Bruno Chiappini1,*, Marc Schepens2, Erwin Tan2, Andrea Dell' Amore1, Wim Morshuis2, Karl Dossche2, Marcello Bergonzini1, Nicola Camurri1, Letizia Bacchi Reggiani1, Giuseppe Marinelli1 and Roberto Di Bartolomeo1

1Department of Cardiovascular Surgery, Policlinico S.Orsola-Malpighi, via Massarenti 9, 40138 Bologna, Italy
2Department of Cardiothoracic Surgery, St Antonius Hospital, Nieuwegein, The Netherlands

Received 25 April 2004; revised 13 September 2004; accepted 23 September 2004; online publish-ahead-of-print 7 December 2004.

* Corresponding author. Tel: 347 5147032; fax: +39 051 345990. E-mail address: bruno_chiappini{at}hotmail.com

Aims The purpose of this retrospective study was to assess the risk factors for the early and late outcome of the surgical treatment of acute type A aortic dissection, in terms of mortality and morbidity.

Methods and results From 1976 to 2003, 487 patients with acute type A aortic dissection treated surgically were enrolled. Twenty-five pre-operative and intra-operative variables were analysed to identify conditions influencing early and late morbidity and early mortality. The in-hospital mortality rate including operative death was 22% (107 patients). Multivariable analysis indicated that pre-existing cardiac disease (RR=3.7, 95% CI=1.8–7.4) and cardiopulmonary resuscitation (RR=6.8, 95% CI=2.3–20.2) were independent predictors of in-hospital death. The causes of in-hospital mortality were low cardiac output in 32 patients (6.6%), major brain damage in 24 patients (5.9%), haemorrhage in 11 patients (2.2%), sepsis in nine patients (1.8%), visceral ischaemia in eight patients (1.6%), multiple organ failure in seven patients (1.4%), rupture of the thoracic aorta in six patients (1.2%), respiratory failure in six patients (1.2%), and four intra-operative deaths. The follow-up was 100% complete. The actuarial survival was 94.9±1.2% and 88.1±2.6%, at 5 and 10 years, respectively.

Conclusions Patients' pre-operative co-morbidities and dissection-related complications significantly affect early and late survival and morbidity after surgical treatment of acute type A aortic dissection.

Key Words: Aortic dissection • Aorta • Surgery


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