What is the Optimal Management of Late Presenting Survivors of Acute Type A Aortic Dissection?
Type A aortic dissections represent a surgical emergency, yet there are those patients who do not receive immediate surgical treatment after the onset of their symptoms. The natural history of these patients, their reasons for delay in presentation or surgical correction, and their comparative clinical courses are not well defined. Data on 195 patients with type A dissections followed at Yale New Haven Hospital between 1985 and 2005 have been collected prospectively and retrospectively. Ninety-two (47.2%) patients received surgical treatment ¡Ý 48 hours after the initial onset of pain or did not receive any surgical treatment (Group A); the remaining 103 patients underwent immediate operative repair within 48 hours of symptom onset (Group B). Median follow-up was 41.8 months (range 0-386). Patients in Group A were older (68.8 vs. 59.3 yrs, p = 0.0005) and had a higher incidence of debilitating comorbidities: coronary artery disease (42.5% vs. 14.6%, p < 0.0001), pulmonary disease (26.6% vs. 8.4%, p = 0.0023) and congestive heart failure (14.1% vs. 1.0%, p = 0.0004). Long-term survival was similar, although there was a trend toward improved 30-day mortality in Group B (16.5% vs. 8.7%, p = 0.1035). Of the 92 patients in Group A, 53 (57.6%) eventually underwent operative repair a median of 8.2 days following symptom onset. There was a trend toward improved long-term survival among patients undergoing repair (p = 0.1031). Patients who have survived 48 hours beyond the initial onset of symptoms from type A aortic dissection represent a subset of patients that appear more stable than once believed. In this specific group, optimization of clinical condition through treatment of comorbidity and full diagnostic work-up, even at the price of delayed or deferred surgical correction, produces very acceptable short and long term morbidity and mortality.
Advisor:John Alex Elefteriades
School Location:USA - Connecticut
Source Type:Master's Thesis
Keywords:type a aortic dissection
Date of Publication:11/09/2006