Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors

Detalhes bibliográficos
Autor(a) principal: Chaves, Ana Cecilia
Data de Publicação: 2019
Tipo de documento: Dissertação
Idioma: eng
Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
Texto Completo: http://hdl.handle.net/10316/90083
Resumo: Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
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spelling Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictorsTratamento cirúrgico da disseção aguda da aorta tipo A: resultados a longo prazo e preditores de mortalidadeAorta torácicaPatologias aórticasResultados perioperatóriosFalso lumenResultados a longo-prazoThoracic aortaAortic diseasesPerioperative resultsFalse lumenLong-term outcomesTrabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de MedicinaBackground & Aims: Acute aortic dissection (AD) of the ascending aorta (type A) is a severe condition that generally prompts emergent surgical repair due to its associated life-threatening complications. Debate continues regarding the optimal approach to treating this condition. We sought to analyse the perioperative outcomes and long-term surgical results as well as to determine predictors of mortality.Patient population and methods: From January 1989 to October 2018, a total of 213 patients aged 20-85 years (mean 61.1±12.6 years), 70.4% (n=150) of which males, underwent surgery for acute Stanford type A AD. Of these, 87.3% (n=186) had DeBakey type I AD. Survival curves were plotted using Kaplan-Meier methods and early and late mortality predictors were determined by logistic regression or Cox regression models, respectively. Average follow-up time was 8.1±6.7 years (median 6.7 years, maximum 29.9 years). Results: Perioperative mortality was 8%, with the most frequent causes being acute myocardial infarction and abdominal ischemia. Haemorrhage was the most common postoperative complication. Chronic renal failure (HR, 26.90; 95% CI, 1.77-408.50; p=0.02) and extracorporeal (ECC) time (HR, 1.03; 95% CI, 1.01-1.04; p=0.001) were the two found predictors of early mortality. Death after hospital discharge occurred in 34.7% (n=68) of patients, mostly due to sudden death and cerebrovascular accident (CVA). Median survival time was 13.53±1.99 (95% CI, 9.63-17.43). At the completion of this study 60.1% (n=128) of patients were alive. Patients with AD showed a 2-fold decrease in life expectancy (Standard mortality rate: 2.11; 95% CI, 1.65-2.69; p<0.0001) relatively to the age- and gender-adjusted general population. Age (HR, 1.07; 95% CI, 1.05-1.10; p<0.001), chronic renal failure (HR, 11.62; 95% CI, 3.38-39.99; p<0.001), aortic valve homograft surgery (HR, 8.22; 95% CI, 2.29-29.51; p=0.001), ECC time (HR, 1.01; 95% CI, 1.01-1.02; p<0.001) and postoperative acute renal failure (HR, 5.22; 95% CI, 1.82-15.00; p=0.002) were the definitive independent predictors of overall mortality in our study population. Residual patent false lumen was present in 59.4% (n=82) of the 138 patients that had follow-up CT records. Conclusions: Surgery for acute type A AD is associated with an acceptable mortality. However, these patients have impaired late survival in comparison with the general population and an important percentage still carries residual disease over time. Regular postoperative follow-up is mandatory for early detection and treatment of late complications and alternative surgical procedures should be pursued to keep improving long-term outcomes.Background & Aims: Acute aortic dissection (AD) of the ascending aorta (type A) is a severe condition that generally prompts emergent surgical repair due to its associated life-threatening complications. Debate continues regarding the optimal approach to treating this condition. We sought to analyse the perioperative outcomes and long-term surgical results as well as to determine predictors of mortality.Patient population and methods: From January 1989 to October 2018, a total of 213 patients aged 20-85 years (mean 61.1±12.6 years), 70.4% (n=150) of which males, underwent surgery for acute Stanford type A AD. Of these, 87.3% (n=186) had DeBakey type I AD. Survival curves were plotted using Kaplan-Meier methods and early and late mortality predictors were determined by logistic regression or Cox regression models, respectively. Average follow-up time was 8.1±6.7 years (median 6.7 years, maximum 29.9 years). Results: Perioperative mortality was 8%, with the most frequent causes being acute myocardial infarction and abdominal ischemia. Haemorrhage was the most common postoperative complication. Chronic renal failure (HR, 26.90; 95% CI, 1.77-408.50; p=0.02) and extracorporeal (ECC) time (HR, 1.03; 95% CI, 1.01-1.04; p=0.001) were the two found predictors of early mortality. Death after hospital discharge occurred in 34.7% (n=68) of patients, mostly due to sudden death and cerebrovascular accident (CVA). Median survival time was 13.53±1.99 (95% CI, 9.63-17.43). At the completion of this study 60.1% (n=128) of patients were alive. Patients with AD showed a 2-fold decrease in life expectancy (Standard mortality rate: 2.11; 95% CI, 1.65-2.69; p<0.0001) relatively to the age- and gender-adjusted general population. Age (HR, 1.07; 95% CI, 1.05-1.10; p<0.001), chronic renal failure (HR, 11.62; 95% CI, 3.38-39.99; p<0.001), aortic valve homograft surgery (HR, 8.22; 95% CI, 2.29-29.51; p=0.001), ECC time (HR, 1.01; 95% CI, 1.01-1.02; p<0.001) and postoperative acute renal failure (HR, 5.22; 95% CI, 1.82-15.00; p=0.002) were the definitive independent predictors of overall mortality in our study population. Residual patent false lumen was present in 59.4% (n=82) of the 138 patients that had follow-up CT records. Conclusions: Surgery for acute type A AD is associated with an acceptable mortality. However, these patients have impaired late survival in comparison with the general population and an important percentage still carries residual disease over time. Regular postoperative follow-up is mandatory for early detection and treatment of late complications and alternative surgical procedures should be pursued to keep improving long-term outcomes.2019-01-252025-01-23T00:00:00Zinfo:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/masterThesishttp://hdl.handle.net/10316/90083http://hdl.handle.net/10316/90083TID:202477126engChaves, Ana Ceciliainfo:eu-repo/semantics/embargoedAccessreponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAP2023-10-27T10:56:44Zoai:estudogeral.uc.pt:10316/90083Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T21:10:17.456524Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse
dc.title.none.fl_str_mv Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
Tratamento cirúrgico da disseção aguda da aorta tipo A: resultados a longo prazo e preditores de mortalidade
title Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
spellingShingle Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
Chaves, Ana Cecilia
Aorta torácica
Patologias aórticas
Resultados perioperatórios
Falso lumen
Resultados a longo-prazo
Thoracic aorta
Aortic diseases
Perioperative results
False lumen
Long-term outcomes
title_short Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
title_full Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
title_fullStr Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
title_full_unstemmed Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
title_sort Surgical treatment of acute aortic dissection type A: long-term outcomes and mortality predictors
author Chaves, Ana Cecilia
author_facet Chaves, Ana Cecilia
author_role author
dc.contributor.author.fl_str_mv Chaves, Ana Cecilia
dc.subject.por.fl_str_mv Aorta torácica
Patologias aórticas
Resultados perioperatórios
Falso lumen
Resultados a longo-prazo
Thoracic aorta
Aortic diseases
Perioperative results
False lumen
Long-term outcomes
topic Aorta torácica
Patologias aórticas
Resultados perioperatórios
Falso lumen
Resultados a longo-prazo
Thoracic aorta
Aortic diseases
Perioperative results
False lumen
Long-term outcomes
description Trabalho Final do Mestrado Integrado em Medicina apresentado à Faculdade de Medicina
publishDate 2019
dc.date.none.fl_str_mv 2019-01-25
2025-01-23T00:00:00Z
dc.type.status.fl_str_mv info:eu-repo/semantics/publishedVersion
dc.type.driver.fl_str_mv info:eu-repo/semantics/masterThesis
format masterThesis
status_str publishedVersion
dc.identifier.uri.fl_str_mv http://hdl.handle.net/10316/90083
http://hdl.handle.net/10316/90083
TID:202477126
url http://hdl.handle.net/10316/90083
identifier_str_mv TID:202477126
dc.language.iso.fl_str_mv eng
language eng
dc.rights.driver.fl_str_mv info:eu-repo/semantics/embargoedAccess
eu_rights_str_mv embargoedAccess
dc.source.none.fl_str_mv reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron:RCAAP
instname_str Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
instacron_str RCAAP
institution RCAAP
reponame_str Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
collection Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
repository.name.fl_str_mv Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação
repository.mail.fl_str_mv
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