Outcome of 290 patients with aortic dissection. A 12-year multicentre experience

Abstract

Retrospective data regarding 290 patients suffering from spontaneous aortic dissection between January 1976 and June 1987 are reported. Dissection was always documented by retrograde aortography and data were collected from 11 catheterization laboratories operating in North-East Italy. The results show that over a 12-year period there was an increase in cases, an increase in the number of operations and a decline in operative mortality. Multivariate discriminant analysis demonstrated that acute myocardial infarction, persistent shock and persistent central neurologic deficit were significant independent predictors of operative mortality in type A patients. Only persistent shock was significantly related to higher operative mortality in type B patients. Late deaths occurred in 14/118 operated patients, and were mostly secondary (directly or indirectly) to aortic dissection. Discharged patients underwent frequent medical checks and chronically received drugs to control hypertension and reduce inotropism. Most of them (73.7%) were asymptomatic: careful post-operative medical assistance is necessary to guarantee the long-term success of surgical treatment.

Predicting Death in Patients With Acute Type A Aortic Dissection

“…5,[11][12][13][14]16,17,24 The similarities of variables predicting in-hospital death in these prior reports and our study support the clinical relevancy of the current predictive model. That older age is associated with worse outcomes is not surprising and is consistent with prior reports.…”

“…5,10 -18 Furthermore, these studies have focused their attention on the surgically treated cohort rather than all patients with dissection presenting to their institution. 10 -17,19 -21 Most have not distinguished acute from chronic stable, 5,10 -12,14,17,19,21 or type A from B 11,14,17,19,21 dissection, conditions that have different natural histories and call for different treatment strategies. As such, at present, the predictors of death in large, unselected, consecutive acute type A aortic dissection patients are not well known.…”

Long-Term Survival in Patients Presenting With Type A Acute Aortic Dissection

“…Contrary to their in hospital trajectory, our analysis found that the patients 13 Two-thirds of patients who survive the index hospitalization without surgical correction were alive at 3 years. This is in contrast to the Ͻ20% survival at 1 year in the medically treated patients reported by Chirillo et al 14 This contemporary perspective of the medically treated type A patients who survive to hospital discharge supports aggressive medical treatment and imaging surveillance among patients who for various reasons are not able to undergo surgery. Many previous reports have elucidated independent predictors of in-hospital death such as age, visceral ischemia, hypotension, renal failure, tamponade, coma, pulse deficits, and malperfusion syndromes in general.…”

“…An additional 10% to 20% are unknown and 8% to 25% are sudden cardiac death. 3,12,14,17 Therefore, at least 50% of death after discharge from the hospital may not be directly related to their repaired aorta but likely from other comorbid conditions.…”

Predictability of aortic dissection as a function of aortic diameter

“…These comprise severe aortic valve regurgitation, rapid antero-or retrograde progression of the dissection inducing coronary, carotid or spinal ischaemia, and pericardial effusion or intrapericardial rupture with haemorrhagic tamponade' 17 '. In these cases, surgery is mandatory since survival in patients not treated surgically is severely impaired with a mortality rate of 18% in the first 15 min, 22% in the first 6 h and 65-75% in the first week after the diagnosis' 14 ' 5 ' 8 ' 9 ' with an overall estimate of 1 % per h during the first 48 h" 01 ".…”