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European Heart Journal Advance Access published online on December 7, 2004
European Heart Journal, doi:10.1093/eurheartj/ehi024
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European Heart Journal © The European Society of Cardiology 2004; all rights reserved.

Clinical research

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

Bruno Chiappini 1*, Marc Schepens 2, Erwin Tan 2, Andrea Dell' Amore 1, Wim Morshuis 2, Karl Dossche 2, Marcello Bergonzini 1, Nicola Camurri 1, Letizia Bacchi Reggiani 1, Giuseppe Marinelli 1, and Roberto Di Bartolomeo 1

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

* To whom correspondence should be addressed.
Bruno Chiappini, E-mail: bruno_chiappini{at}hotmail.com


  Abstract

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.

Keywords: Aortic dissection; Aorta; Surgery.
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