Long-term Results and Quality of Life after Surgery for Acute Aortic Dissection Type A: Contemporary Single-Centre Experience

Background: Aortic dissection type A is a life-threatening disease not only in the acute phase but also in follow-up it carries an elevated risk of subsequent morbidity and mortality. To assess long-term outcomes and quality of life after emergency surgery for acute aortic dissection type A in a large single-center patient cohort.

Methods: A total of 413 patients were analyzed, operated between 2000 and 2016 at our center. We compared our results of the early (2000–2007) versus late (2008–2016) period with regards to 30-day, 1-, 5-, and 10- year mortality and need for reoperation. Risk factors were searched by multivariate regression. Quality of life was assessed by SF-36 survey.

Results: Mean age was 64 [IQR 21] years, 65.9% were male, and calculated perioperative risk using log. EuroSCORE was median 36.3% [IQR 35.3] with a significant increase over time: 24.9% in early versus 38.0% in late period, p < 0.001. There were significantly more total arch replacements (± frozen elephant trunk) in the late period: 38.3% versus 26.7% (early period), p < 0.001). Accordingly circulatory arrest times increased over time from median 25 [31] to 35 [40] minutes (p < 0.001), whereas cardiopulmonary bypass and cross-clamp times remained comparable (early 185 [89] and 125 [58] vs. late 197 [73] and 132 [57] minutes, p = 0.12 and 0.61). Overall 30-day rates of mortality decreased significantly: 26.7% in early vs. 17.4% in late period at 30 days (p = 0.03). Survival at 1-, 5-, and 10-years was 92.3% versus 91.8% (p = 0.91), 75.2% versus 81.0% (p = 0.29), and 53.4% versus 69.7% (p = 0.04). Freedom from reoperation was comparable between groups at 10 years of follow-up: 80.5% versus 85.7%, p = 0.32. Quality of life by SF-36 assessment was worse compared with a healthy reference population in almost all aspects but mental health which showed to be superior for the study group.

Conclusion: Despite more complex severity of disease and operative procedures results of emergency surgery for type A aortic dissection improved significantly over time at 30-days and in 10-year follow-up. Quality of life is significantly impaired except superior mental health compared with a healthy reference population.

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Artikel online veröffentlicht:
13. Februar 2024