Abstract
Background:
The goal of this study was to compare operative mortality and actuarial survival
between patients presenting with and without hemodynamic instability who underwent
repair of acute Type A aortic dissection. Previous studies have demonstrated that
hemodynamic instability is related to differences in early and late outcomes following
acute Type A dissection occurrence. However, it is unknown whether hemodynamic instability
at the initial presentation affects early clinical outcomes and survival after repair
of Type A aortic dissection.
Methods:
A total of 251 patients from four academic medical centers underwent repair of acute
Type A aortic dissection between January 2000 and October 2010. Of those, 30 presented
with hemodynamic instability while 221 patients did not. Median ages were 63 years
(range 38-82) and 60 years (range 19-87) for patients presenting with hemodynamic
instability compared to patients without hemodynamic instability, respectively (P = 0.595). Major morbidity, operative mortality, and 10-year actuarial survival were
compared between groups.
Results:
Operative mortality was profoundly influenced by hemodynamic instability (patients
with hemodynamic instability 47% versus 14% for patients without hemodynamic instability,
P < 0.001). Actuarial 10-year survival rates for patients with hemodynamic instability
were 44% versus 63% for patients without hemodynamic instability (P = 0.007).
Conclusions:
Hemodynamic instability has a profoundly negative impact on early outcomes and operative
mortality in patients with acute Type A aortic dissection. However, late survival
is comparable between hemodynamically unstable and non-hemodynamically unstable patients.
Key Words
Aortic dissection - Hemodynamics - Surgery
