Life Expectancy of Survivors of Type A Aortic Dissection: A Comparison with the General Population Over a Period of 40 Years

Objectives: Acute Type A aortic dissection (AAD) is a life-threatening entity requiring immediate surgery, which still carries a high morbidity and mortality. Numerous studies have analyzed the survival after surgery in patients with AAD. Nevertheless, little is known about the life expectancy of survivors of surgery for AAD compared to the general population. The current study follows an age/sex adjusted approach to analyze the long-term survival benefit of patients, who survived the initial phase after surgery, compared with the overall life expectancy in Germany.

Methods: We analyzed 414 patients who underwent surgery for AAD at our institution between 1977 and 2016. Twenty-one patients with known syndromes such as Marfan were excluded. Patient’s survival was compared with actuarial tables from the German national registry. Data were adjusted for age, sex, and year of birth. Cox regression analysis was performed for survival analysis.

Results: A total of 270 patients survived the first year after surgery and were further analyzed. Complete follow-up could be achieved. Median age was 57.2 years ± 14.2, 73 (27.0%) patients were female, 58 (21.4%) patients underwent isolated aorta ascendens replacement, and all other patients underwent more complex surgical procedures. Median follow up was 9.43 years according to reverse Kaplan–Meier.

One-year survivors of surgery for AAD face an impaired long-term survival compared to the life expectancy of the general population (HR 1.8, p < 0000.1) (shown in table). In patients under 60 years of age, survival is markedly reduced compared to general population (HR 2.2, p < 0.001). That applies also to patients elder than 60 (HR 1.7, p < 0.001).

Nevertheless, survivors of an isolated replacement of the ascending aorta have a normal life expectancy: No statistical difference with the general population could be observed (HR = 1.37, p = 0.2). All patients, who needed more surgery than an isolated aorta ascendens replacement, had a significantly impaired survival (HR = 1.98, p < 0.001) (shown in table).

Conclusion: Survivors of surgery for AAD, who had an isolated replacement of the ascending aorta, have a normal life expectancy compared with the general population, adjusted for age, sex and year of birth. The overall life expectancy of survivors, however, is reduced.

	Standardized incidence ratio for mortality	p-Value
Note: Standardized incidence ratios for mortality compared to age-/sex-adjusted general population in Germany (95% CI).
All 1-y survivors	1.81 (1.43–2.27)	<0.001
Isolated aorta ascendens replacement	1.37 (0.79–2.23)	0.20
All other than isolated aorta ascendens replacement	1.98 (1.51–2.56)	<0.001