Dissection of the aorta and dissecting aortic aneurysms: Improving early and long-term surgical results

We report the improving surgical results in a consecutive series of 690 patients referred to one of us (E.S.C.) for aortic dissection between December 1956 and September 1989, a substantial portion of whom had dissection as a complication of either previous aortic (n=113, 16) or previous cardiac (n=54, 8%) operation. Our initial operation of choice in patients requiring multiple operations in this group of 690 patients was based on the most life-threatening or symptomatic aortic segment involved, which was ascending aorta and/or aortic arch (Asc/Arch) in 301 (44%) patients, descending thoracic aorta (Desc) in 195 (28%) patients, and thoracoabdominal aorta (TaA) in 194 (28%) patients. As detailed below, considerable improvement occurred in the 30-day survival rates over time, particularly for acute dissection: Acute Chronic Asc/Arch Before 1986 67% (30/45) p=0.0019 88% (86/98) p=03 1986 and after 95% (35/37) 92% (111/121) Desc Before 1984 55% (12/22) p=0.0065 83% (50/60) p=0.0079 1984 and after 94% (16/17) 96% (92/96) TaA Before 1984 53% (8/15) p=0.0047 90% (54/60) p=0.2 1984 and after 95% (18/19) 95% (95/100) The independent determinants of both early and long-term mortality were identified. Independent determinants of late fatal rupture, reoperation, and neuromuscular dysfunction for distal dissectors were also identified. In our experience, continued aggressive surgical intervention for aortic dissection with modern operative techniques has resulted in markedly improved 30-day operative survival (approaching 95% including those patients with acute dissection) and significant improvement in late results.