Cardiac surgery for ascending aortic dissection has a good short-term and medium-term prognosis in a paired-matched analysis

Introduction

Aortic dissection has an ominous prognosis if it is not promptly surgically corrected. Despite surgical intervention, patients suffer from high morbidity–mortality. Our aim was to compare the incidence of postoperative complications and 1-month and 6-month mortality of ascending aortic dissection surgical correction with paired matched controls for elective aortic aneurysm correction and urgent coronary artery bypass graft surgery (CABG).

Methods

Ascending aortic dissection (AAD) and aneurysm correction surgeries were gathered from February 2005 to June 2008, in a private community ICU. Demographic data, co-morbidities and cardiac ejection fraction were collected. Euroscore, Ontario and APACHE II scores were calculated to analyze patients' severity of illness. Surgical characteristics (elective or urgent indications) and peroperative data were also compared. AAD patients were compared against elective aortic aneurysms (ascending aorta controls) and all CABG (standard cardiac procedure control) surgeries. Besides, aortic dissection and aneurysm surgeries were compared with paired matched CABG control patients, according to age (± 3 years), gender, elective/urgent procedure and surgical team. At first, simple comparisons were made between ascending aorta and CABG surgeries. Aortic dissection and aneurysm groups were analyzed against each other; and finally AAD patients were compared with paired matched CABG brackets for morbidity (postoperative complications and ICU and hospital lengths of stay) and 1-month and 6-month mortality.

Results

Twelve patients were operated for AAD correction and 10 for ascending aortic aneurysm, while 246 patients were submitted to CABG surgery. Ascending aorta surgical patients were younger (mean ± SD, 60.8 ± 16.2 vs 66.1 ± 10.2, P = 0.03) when compared with CABG brackets. APACHE II, Euroscore and Ontario were higher for aorta patients (P < 0.01). Rates of urgent procedures were also similar in ascending aorta and CABG patients (54 vs 39%, P = NS). Incidences of postoperative complications were significantly higher in the aorta group (77 vs 36%, P < 0.001), as well as higher ICU length of stay (8.7 ± 16.1 vs 3.3 ± 4.5 days, P < 0.001), but similar ICU mortality (4.5 vs 3.2%, P = NS). When AAD patients were compared with the aneurysm group, the main differences were: more urgent procedures in ascending aortic dissection patients (91 vs 10%, P < 0.001), longer length of mechanical ventilation (45.1 ± 57.5 vs 7.3 ± 6.1, P = 0.05), and length of hospital stay (34.6 ± 35.8 vs 10.6 ± 4.7, P = 0.05). Incidences of postoperative complications and 1-month and 6-month mortality were similar in these groups. After matching paired CABG patients to the AAD group, significantly worse results were found for the last group: Euroscore (10.1 ± 3.3 vs 5.9 ± 4.1, P = 0.02) and Ontario (7.0 ± 1.2 vs 4.3 ± 3.0, P = 0.01) scores, higher incidence of postoperative complications (91 vs 45%, P = 0.03), and longer hospital length of stay (34.6 ± 35.8 vs 12.9 ± 8.5 days, P = 0.05). However, 1-month and 6-month mortality was very similar in both groups (8 and 16%, respectively; P = NS).

Conclusion

Although AAD surgical correction is associated with increased incidence of postoperative complications and hospital length of stay, 1-month and 6-month mortality is very similar to elective aortic aneurysm repair and paired matched CABG controls.