Thorac Cardiovasc Surg 2019; 67(05): 363-371
DOI: 10.1055/s-0038-1649511
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Impact of Different Aortic Entry Tear Sites on Early Outcomes and Long-Term Survival in Patients with Stanford A Acute Aortic Dissection

Julia Merkle
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Anton Sabashnikov
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Antje Christin Deppe
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Saskia Weber
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Navid Mader
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Yeong-Hoon Choi
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Oliver Liakopoulos
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Ferdinand Kuhn-Régnier
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
,
Thorsten Wahlers
1  Department of Cardiothoracic Surgery, University Hospital of Cologne, Cologne, Germany
› Author Affiliations
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
Further Information

Publication History

08 February 2018

26 March 2018

Publication Date:
13 June 2018 (online)

Abstract

Background Stanford A acute aortic dissection (AAD) is a life-threatening emergency. The aim of this study was to compare the impact of three different aortic entry tear sites on early outcomes and long-term survival of patients with Stanford A AAD.

Methods From January 2006 to April 2015, a total of 240 consecutive patients with diagnosed Stanford A AAD underwent emergent, isolated surgical aortic repair in our center. Patients were divided into three groups comprising isolated ascending aorta, proximal aortic arch, and distal aortic arch entry tear site and were followed up for up to 9 years.

Results Thirty-day mortality as well as major cerebrovascular events were significantly different between the three groups (p = 0.007 and p = 0.048, respectively). Overall cumulative short- and long-term survival of all patients revealed significant differences (Log-Rank p = 0.002), whereas survival of all patients free from major cerebrovascular events was similar (Log-Rank p = 0.780). Subgroup analysis of short- and long-term survival of patients showed significant differences in terms of men (Log-Rank p = 0.043), women (Log-Rank p = 0.004), patients over 65 years of age (Log-Rank p = 0.007), and hypertensive patients (Log-Rank p = 0.003). Kaplan–Meier survival estimation plots significantly showed poorest survival for distal aortic arch entry tear site group.

Conclusion The location of the primary entry tear in patients with Stanford A AAD significantly influences early outcomes, short- and long-term survival of patients, whereas survival of patients free from major cerebrovascular events showed similar results among the three groups. Distal aortic entry tear site showed poorest outcomes and survival.