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CC BY 4.0 · Aorta (Stamford) 2014; 02(01): 22-27
DOI: 10.12945/j.aorta.2014.13-055
Original Research Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Effects of Hemodynamic Instability on Early Outcomes and Late Survival Following Repair of Acute Type A Aortic Dissection

Brian D. Conway
1   Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Sotiris C. Stamou
1   Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa
,
Nicholas T. Kouchoukos
2   Division of Cardiothoracic Surgery, Missouri Baptist Medical Center, Saint Louis, Missouri
,
Kevin W. Lobdell
3   Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center, Charlotte, North Carolina
,
Kamal Khabbaz
4   Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
,
Lawrence H. Patzelt
5   Thoracic and Cardiovascular Surgery, Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute, Grand Rapids, Michigan
,
Robert C. Hagberg
6   Department of Cardiac Surgery, Hartford Hospital, Hartford, Connecticut
› Institutsangaben
Weitere Informationen

Publikationsverlauf

31. Oktober 2013

06. Januar 2014

Publikationsdatum:
24. September 2018 (online)

   Lizenzen und Reprints

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
 

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