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.
Keywords
Stanford A acute aortic dissection - ascending aorta - aortic hemiarch - aortic arch
- outcomes - entry tear
