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(Circulation. 2006;114:I-350 – I-356.)
© 2006 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

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

Insights from the International Registry of Acute Aortic Dissection (IRAD)

Thomas T. Tsai, MD; Arturo Evangelista, MD; Christoph A. Nienaber, MD; Santi Trimarchi, MD; Udo Sechtem, MD; Rossella Fattori, MD; Truls Myrmel, MD; Linda Pape, MD; Jeanna V. Cooper, MS; Dean E. Smith, PhD; Jianming Fang, MD; Eric Isselbacher, MD; Kim A. Eagle, MD, on behalf of the International Registry of Acute Aortic Dissection (IRAD)

From University of Michigan Cardiovascular Center, Ann Arbor, Mich.

Correspondence to Thomas T. Tsai, MD, University of Michigan Cardiovascular Center, 24 Frank Lloyd Wright Drive, Lobby A, Room 3201, P.O. Box 384, Ann Arbor, MI 48106-0384. E-mail: hsianshi{at}umich.edu

Background— Earlier studies evaluating long-term survival in type A acute aortic dissection (TA-AAD) have been restricted to a small number of patients in single center experiences. We used data from a contemporary, multi-center international registry of TA-AAD patients to better understand factors associated with long-term survival.

Methods and Results— We examined 303 consecutive patients with TA-AAD enrolled in the International Registry of Acute Aortic Dissection (IRAD) between 1996 and 2003. We included patients who were discharged alive and had documented clinical follow-up data. Kaplan-Meier survival curves were constructed to depict cumulative survival in patients from date of hospital discharge. Stepwise Cox proportional hazards analysis was performed to identify independent predictors of follow-up mortality. We found that 273 (90.1%) patients had been managed surgically and 30 (9.9%) were managed medically. Patients who were dead at follow-up were more likely to be older (63.9 versus 58.4 years, P=0.007) and to have had previous cardiac surgery (23.9% versus 10.6%, P=0.01). Survival for patients treated with surgery was 96.1%±2.4% and 90.5%±3.9% at 1 and 3 years versus 88.6%±12.2% and 68.7%±19.8% without surgery (mean follow-up overall, 2.8 years, log rank P=0.009). Multivariate analysis identified a history of atherosclerosis (relative risk (RR), 2.17; 95% confidence interval [CI], 1.08 to 4.37; P=0.03) and previous cardiac surgery (RR, 2.54; 95% CI, 1.16 to 5.57; P=0.02) as significant, independent predictors of follow-up mortality.

Conclusions— Contemporary 1- and 3-year survival in patients with TA-AAD treated surgically are excellent. Independent predictors of survival during the follow-up period do not appear to be influenced by in-hospital risks but rather preexisting comorbidities.

Key Words: aorta • mortality • risk factors • surgery

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