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(Circulation. 2006;114:I-357 – I-364.)
© 2006 American Heart Association, Inc.

Surgery for Aortic and Peripheral Vascular Disease

Role and Results of Surgery in Acute Type B Aortic Dissection

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

Santi Trimarchi, MD; Christoph A. Nienaber, MD; Vincenzo Rampoldi, MD; Truls Myrmel, MD; Toru Suzuki, MD; Eduardo Bossone, MD; Valerio Tolva, MD; Michael G. Deeb, MD; Gilbert R. Upchurch, Jr, MD; Jeanna V. Cooper, MS; Jianming Fang, MD; Eric M. Isselbacher, MD; Thoralf M. Sundt, 3rd, MD; Kim A. Eagle, MD, on behalf of the IRAD Investigators

From the Cardiovascular Center "E. Malan" (S.T., V.R., V.T.), Policlinico S. Donato, S. Donato Milanese, Italy; University of Rostock (C.A.N.), Rostock, Germany; Tromsø University Hospital (T.M.), Tromsø, Norway; University of Tokyo (T.S.), Japan; National Research Council (E.B.), Lecce, Italy; University of Michigan (M.G.D., G.R.U., J.V.C., J.F., K.A.E.); Ann Arbor, Michigan; Massachusetts General Hospital (E.M.I.), Boston, Massachusetts; Mayo Clinic (T.M.S.), Rochester, Minnesota.

Correspondence to Santi Trimarchi, Cardiovascular Center "E. Malan", Policlinico San Donato, via Morandi 30, 20097 S. Donato Milanese, Italy. E-mail satrimarchi{at}yahoo.it

Background— The clinical profiles and outcomes of patients treated surgically for acute type B aortic dissection (ABAD) are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era.

Methods and Results— A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; mean±SD age, 60.6±15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter >6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age >70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49).

Conclusions— The present study provides insights into current-day clinical profiles and surgical outcomes of ABAD. Knowledge about different preoperative clinical conditions may help surgeons in making treatment decisions among these high-risk patients.

Key Words: aorta • aortic diseases • disease management • treatment outcome