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

AORTA

article

Brian D. Conway¹  Sotiris C. Stamou¹  Nicholas T. Kouchoukos²  Kevin W. Lobdell³  Kamal Khabbaz⁴  Lawrence H. Patzelt⁵  Robert C. Hagberg⁶ 

[1] Department of Cardiothoracic Surgery, University of Iowa Hospitals and Clinics;Division of Cardiothoracic Surgery, Missouri Baptist Medical Center;Department of Thoracic and Cardiovascular Surgery, Sanger Heart and Vascular Institute, Carolinas Medical Center;Division of Cardiac Surgery, Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School;Spectrum Health, Fred and Lena Meijer Heart and Vascular Institute;Department of Cardiac Surgery, Hartford Hospital

关键词: Aortic dissection;    Hemodynamics;    Surgery;   

DOI  :  10.12945/j.aorta.2014.13-055

来源: Thieme

【 摘 要 】

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.

【 授权许可】

Unknown