Improving outcomes of surgery for acute type A aortic dissection

Figures & data

Table 1. Perfusion and operative characteristics in all patients and groupwise (Recent vs Earlier, Survivors vs Dead).

Variable	All patients (n = 204)	Recent (n = 102)	Earlier (n = 102)	p Value	Survivors (n = 185)	Dead (n = 19)	p Value
CPB time, min	175 (58)	166 (43)	184 (69)	.027	167 (42)	250(113)	<.001
AXC time, min	105 (46)	102 (41)	110 (51)	.17	102 (42)	142 (70)	<.001
HCA	198 (97)	97 (95)	101 (99)	.097	179 (97)	19 (100)	.43
HCA time, min	38 (18)	36 (16)	40 (19)	.077	37 (17)	47 (23)	.027
Cerebral perfusion time, min	29 (17)	28 (16)	30 (17)	.47	29 (16)	34 (19)	.19
Cerebral perfusion
Unilateral	2 (1.0)	0	2 (2.0)	.17	1 (0.6)	1 (5.3)	.052
Bilateral	23 (12)	10 (10)	13 (13)	.59	20 (11)	3 (16)	.56
Bilateral + LSA	165 (84)	86 (90)	79 (78)	.031	151 (85)	14 (74)	.21
Unknown	7 (3.5)	0	7 (6.8)		6 (3.4)	1 (5.6)
Primary arterial cannulation
Femoral	190 (93)	95 (93)	95 (93)	1.0	172 (93)	18 (95)	.77
Axillary	3 (1.5)	2 (2.0)	1 (1.0)	.56	3 (1.6)	0	.58
Aortic	11 (5.4)	5 (4.9)	6 (5.9)	.76	10 (5.4)	1 (5.3)	.98
Aortic segment(s) replaced
Root	55 (27)	31 (30)	24 (24)	.27	46 (25)	9 (47)	.035
Ascending	204(100)	102 (100)	102(100)	1.0	185(100)	19 (100)	1.0
Hemiarch	25 (12)	14 (14)	11 (11)	.52	21 (11)	4 (21)	.22
Total arch	10 (4.9)	3 (2.9)	7 (6.9)	.19	7 (3.8)	3 (16)	.021
Descending (FET)	4 (2.0)	0	4 (3.9)	.043	2 (1.1)	2 (11)	.005
Aortic valve
Replacement	55 (27)	30 (29)	25 (25)	.43	47 (25)	8 (42)	.12
Resuspension	69 (34)	31 (30)	38 (37)	.30	63 (34)	6 (32)	.83
Concomitant CABG	8 (3.9)	0	8 (7.8)	.004	3 (1.6)	5 (26)	<.001
Restart CPB	12 (5.9)	6 (5.9)	6 (5.9)	1.0	7 (3.8)	5 (26)	<.001
Repeat AXC	16 (7.8)	9 (8.8)	7 (6.9)	.60	13 (7.0)	3 (16)	.18
Repeat HCA	6 (2.9)	2 (2.0)	4 (3.9)	.41	3 (1.6)	3 (16)	<.001

XC: aortic cross-clamp; CABG: coronary artery bypass grafting; CPB: cardiopulmonary bypass; FET: frozen elephant trunk; HCA: hypothermic circulatory arrest; LSA: left subclavian artery.

Table 2. Preoperative characteristics in all patients and groupwise (Recent vs Earlier, Survivors vs Dead).

Variable	All patients (n = 204)	Recent (n = 102)	Earlier (n = 102)	p Value	Survivors (n = 185)	Dead (n = 19)	p Value
Age, years	62 (13)	62 (14)	64 (12)	.35	62 (13)	67 (8.9)	.076
Male	140 (69)	68 (67)	72 (71)	.55	128 (69)	12 (63)	.59
Hypertension	104 (51)	56 (55)	48 (47)	.26	96 (52)	8 (42)	.42
COPD	8 (4.0)	4 (4.0)	4 (4.0)	1.0	8 (4.4)	0	.37
Smoking	116 (59)	57 (56)	59 (58)	.95	104 (58)	12 (63)	.41
Diabetes	9 (4.5)	5 (5.0)	4 (4.0)	.73	9 (4.9)	0	.34
Bicuspid aortic valve	9 (4.5)	5 (5.0)	4 (4.0)	0.8	9 (4.9)	0	.53
Connective tissue disorder	4 (2.0)	2 (2.0)	2 (2.0)	1.0	4 (2.2)	0	.52
Previous cardiac surgery	7 (3.4)	2 (2.0)	5 (4.9)	.25	6 (3.2)	1 (5.3)	.65
EuroSCORE II	13 (16)	14 (16)	12 (16)	.51	12 (13)	49 (25)	<.001
DeBakey I	135 (66)	63 (62)	72 (71)	.18	119 (64)	16 (84)	.081
Shock	56 (28)	25 (25)	31 (30)	.35	45 (24)	11 (58)	.002
CPR	10 (4.9)	4 (3.9)	6 (5.9)	.52	5 (2.7)	5 (26)	<.001
Tamponade	78 (38)	37 (37)	41 (40)	.56	70 (38)	8 (42)	.72
Penn class
Aa	95 (47)	50 (49)	45 (44)	.48	92 (50)	3 (16)	.005
Ab	53 (26)	27 (26)	26 (26)	.87	48 (25)	5 (26)	.97
Ac	19 (9.3)	9 (8.8)	10 (9.8)	.81	18 (9.7)	1 (5.3)	.52
Abc	37 (18)	16 (16)	21 (21)	.36	27 (15)	10 (53)	<.001
Lactate, mmol/L	2.7 (2.5)	2.8 (2.6)	2.6 (2.4)	.55	2.5 (2.3)	4.3 (3.8)	.003
LVEF
>50%	176 (86)	88 (86)	88 (86)	1.0	165 (89)	11 (58)	<.001
30–50%	23 (11)	12 (12)	11 (11)	.82	17 (9.2)	6 (32)	.003
<30%	1 (0.5)	1 (1.0)	0	.32	1 (.5)	0	.75
Median time from symptom onset to surgery, hours	6.0 (4.0, 16.5)	6.0 (4.0, 13.5)	6.5 (4.0, 24)	.32	6.5 (4.0, 17)	5.0 (4.0,13.5)	.20

COPD: chronic obstructive pulmonary disease; CPR: cardio-pulmonary resuscitation; EuroSCORE II: The European System for Cardiac Operative Risk Evaluation; LVEF: Left Ventricular Ejection Fraction.

Table 3. Postoperative outcomes in all patients and groupwise (Recent vs Earlier, Survivors vs Dead).

Variable	All patients (n = 204)	Recent (n = 102)	Earlier (n = 102)	p Value	Survivors (n = 185)	Dead (n = 19)	p Value
Reexploration	31 (15)	14 (14)	17 (17)	.54	26 (14)	5 (28)	.12
Neurological damage	38 (19)	13 (13)	25 (25)	.028	27 (15)	11 (61)	<.001
Renal insufficiency	69 (34)	36 (35)	33 (33)	.69	57 (31)	12 (67)	.002
Respiratory insufficiency	40 (20)	20 (20)	20 (20)	.97	29 (16)	11 (61)	<.001
Cardiac failure	33 (16)	13 (13)	20 (20)	.17	24 (13)	9 (50)	<.001
Multisystem organ failure	44 (22)	19 (19)	25 (25)	.29	29 (16)	15 (83)	<.001
30-day mortality	19 (9.3)	4 (3.9)	15 (15)	.008	–	–	–

Figure 1. Number of operating surgeons (red), median number of annual operations per surgeon (green), and 30-day mortality (blue) during the study period.

Figure 2. Estimated (Kaplan–Meier) survival for patients operated earlier (red) and recently (blue).