Contemporary results following surgical repair of acute type a aortic dissection (AAAD): A single centre experience

Andrew J M Campbell-Lloyd, Julie Mundy, Nigel Pinto, Annabelle Wood, Elaine Beller, Stephen Strahan, Pallav Shah

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Abstract

OBJECTIVES: The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).

METHODS: Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.

RESULTS: The mean age was 61years; 60% were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45%, malperfusion syndrome in 59%, moderate-severe aortic regurgitation in 48% and tamponade in 16%. EF was <40% in 17%. There was a delay of >12hours between diagnosis and operation in 64%. Axillary cannulation was performed in 37%. Cerebral protection was by hypothermic arrest (HCA) alone (19%), HCA with retrograde cerebral perfusion (RCP) (11%), or HCA with antegrade cerebral perfusion (ACP) (46%). The procedure was performed on cross-clamp in 24%. Full arch replacement was performed in 14% and concomitant coronary artery grafting was performed in 11%. Post-operative neurological dysfunction was present in 33.8%. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53%. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70% at two years, 50% at five years and 25% at nine years. Functional outcomes and long-term quality of life were assessed in 69% of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.

CONCLUSIONS: Discharged patients have reasonable long-term survival and good quality of life.

Original languageEnglish
Pages (from-to)665-72
Number of pages8
JournalHeart Lung and Circulation
Volume19
Issue number11
DOIs
Publication statusPublished - Nov 2010
Externally publishedYes

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Dissection
Quality of Life
Survival
Mortality
Perfusion
Marfan Syndrome
Aortic Valve Insufficiency
Catheterization
Renal Insufficiency
Coronary Vessels
Electrocardiography
Health

Cite this

Campbell-Lloyd, Andrew J M ; Mundy, Julie ; Pinto, Nigel ; Wood, Annabelle ; Beller, Elaine ; Strahan, Stephen ; Shah, Pallav. / Contemporary results following surgical repair of acute type a aortic dissection (AAAD) : A single centre experience. In: Heart Lung and Circulation. 2010 ; Vol. 19, No. 11. pp. 665-72.
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title = "Contemporary results following surgical repair of acute type a aortic dissection (AAAD): A single centre experience",
abstract = "OBJECTIVES: The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).METHODS: Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.RESULTS: The mean age was 61years; 60{\%} were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45{\%}, malperfusion syndrome in 59{\%}, moderate-severe aortic regurgitation in 48{\%} and tamponade in 16{\%}. EF was <40{\%} in 17{\%}. There was a delay of >12hours between diagnosis and operation in 64{\%}. Axillary cannulation was performed in 37{\%}. Cerebral protection was by hypothermic arrest (HCA) alone (19{\%}), HCA with retrograde cerebral perfusion (RCP) (11{\%}), or HCA with antegrade cerebral perfusion (ACP) (46{\%}). The procedure was performed on cross-clamp in 24{\%}. Full arch replacement was performed in 14{\%} and concomitant coronary artery grafting was performed in 11{\%}. Post-operative neurological dysfunction was present in 33.8{\%}. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53{\%}. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70{\%} at two years, 50{\%} at five years and 25{\%} at nine years. Functional outcomes and long-term quality of life were assessed in 69{\%} of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.CONCLUSIONS: Discharged patients have reasonable long-term survival and good quality of life.",
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Contemporary results following surgical repair of acute type a aortic dissection (AAAD) : A single centre experience. / Campbell-Lloyd, Andrew J M; Mundy, Julie; Pinto, Nigel; Wood, Annabelle; Beller, Elaine; Strahan, Stephen; Shah, Pallav.

In: Heart Lung and Circulation, Vol. 19, No. 11, 11.2010, p. 665-72.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Contemporary results following surgical repair of acute type a aortic dissection (AAAD)

T2 - A single centre experience

AU - Campbell-Lloyd, Andrew J M

AU - Mundy, Julie

AU - Pinto, Nigel

AU - Wood, Annabelle

AU - Beller, Elaine

AU - Strahan, Stephen

AU - Shah, Pallav

N1 - Copyright © 2010. Published by Elsevier B.V.

PY - 2010/11

Y1 - 2010/11

N2 - OBJECTIVES: The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).METHODS: Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.RESULTS: The mean age was 61years; 60% were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45%, malperfusion syndrome in 59%, moderate-severe aortic regurgitation in 48% and tamponade in 16%. EF was <40% in 17%. There was a delay of >12hours between diagnosis and operation in 64%. Axillary cannulation was performed in 37%. Cerebral protection was by hypothermic arrest (HCA) alone (19%), HCA with retrograde cerebral perfusion (RCP) (11%), or HCA with antegrade cerebral perfusion (ACP) (46%). The procedure was performed on cross-clamp in 24%. Full arch replacement was performed in 14% and concomitant coronary artery grafting was performed in 11%. Post-operative neurological dysfunction was present in 33.8%. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53%. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70% at two years, 50% at five years and 25% at nine years. Functional outcomes and long-term quality of life were assessed in 69% of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.CONCLUSIONS: Discharged patients have reasonable long-term survival and good quality of life.

AB - OBJECTIVES: The study aims to define predictors of neurological dysfunction, 30-day mortality, long-term survival and quality of life following repair of acute type A aortic dissection (AAAD).METHODS: Between 2000 and 2008, 65 patients underwent repair of AAAD. Sixty-four pre-, intra- and post-operative variables were studied. Mean follow-up was 26.6 months.RESULTS: The mean age was 61years; 60% were male and five had Marfan's syndrome. At presentation, ischaemic ECG changes were seen in 45%, malperfusion syndrome in 59%, moderate-severe aortic regurgitation in 48% and tamponade in 16%. EF was <40% in 17%. There was a delay of >12hours between diagnosis and operation in 64%. Axillary cannulation was performed in 37%. Cerebral protection was by hypothermic arrest (HCA) alone (19%), HCA with retrograde cerebral perfusion (RCP) (11%), or HCA with antegrade cerebral perfusion (ACP) (46%). The procedure was performed on cross-clamp in 24%. Full arch replacement was performed in 14% and concomitant coronary artery grafting was performed in 11%. Post-operative neurological dysfunction was present in 33.8%. The only significant predictor of poor neurological outcome was full arch replacement (p=0.04) on univariate analysis. In-hospital OR 30 mortality was 23.53%. Significant predictors of mortality were low ejection fraction (p=0.017) and post-operative renal failure (p=0.012). Long-term survival was 70% at two years, 50% at five years and 25% at nine years. Functional outcomes and long-term quality of life were assessed in 69% of patients who were alive at last follow-up. Ninety percent of patients reported minimal limitation on functional scores. Quality of life was assessed using the EQ-5D questionnaire. Forty-eight percent of patients recorded full health with an overall mean index of 0.854 (where the best possible score is 1) using the US preference weighted index score.CONCLUSIONS: Discharged patients have reasonable long-term survival and good quality of life.

U2 - 10.1016/j.hlc.2010.05.009

DO - 10.1016/j.hlc.2010.05.009

M3 - Article

VL - 19

SP - 665

EP - 672

JO - Asia Pacific Heart Journal

JF - Asia Pacific Heart Journal

SN - 1444-2892

IS - 11

ER -