Abstract
Introduction. Acute aortic dissection (AAD) is a serious disease
of the aorta with high mortality and morbidity, which requires
emergency surgical treatment in order to close the site of the
dissection and direct blood flow into the true lumen. Improve-
ments in surgical technique have led to better management
of patients with reduced operative mortality, although it still
remains high. The aim of this study is to evaluate early and
late outcomes of the surgical treatment of acute type A aortic
dissection at the hospital of Lecce between 1998 and 2007. We
also aim to establish a correlation between these outcomes and
pre-operative conditions, surgical procedures and location of
the site of the tear.
Methods. From 1998 to 2007, 100 patients (69 males and 31
females, average age 62.2 ± 12.3 years, range 22-85 years)
underwent surgery for acute AAD at the center. Surgical tech-
niques included replacement of the ascending aorta (Asc Ao)
with or without valve replacement (including five patients who
underwent the Bentall/De Bono procedure) and replacement of
the Asc Ao with or without arch or hemiarch replacement.
Results. In-hospital mortality was 22%, with different results
between surgery for replacement of the aorta and for aorta with
valve replacement (respectively, 16% and 23%). Different mor-
tality rates were found between the distal surgical treatments,
with rates of 20.8% and 18.2% respectively between replace-
ments of the Asc Ao and of Asc Ao with arch/hemiarch, although
they were not statistically significant. A different mortality rate
that was subject to the patient?s preoperative condition has also
been found (33.3% of mortality in patients in unstable or high-
risk condition vs 13.8% in patients in stable condition). The peak
reached 43.5% mortality in patients taken to the operating room
while in shock or cardiac tamponade. The location of the site
of the tear is another factor that distinguishes mortality rates,
which are 17.8% if localized at the proximal ascending aorta and
22.2% in the aortic arch. Assessment of the outcome (10 years
after surgery), has shown that four patients died several years
later but for reasons unrelated to the surgery.
Conclusions. The surgery of dissection is still an intervention
with a relatively high in-hospital mortality risk, and whose
outcome, which has been steady in the last 20 years, can be
predicted according to the preoperative condition of the patient.
This underlines the need to reduce the time of diagnosis indicat-
ing immediate surgical treatment.
