Changing surgical management for acute aortic dissections type a improves immediate outcomes.

Background: Surgical treatment of acute aortic dissection type A is well established. This study analyzes the impact of changing surgical management of Type A dissections on hospital mortality and postoperative complications.

Method: Between January 1980 and December 2002, 141 consecutive patients were operated for acute Type A aortic dissection. Patients were analyzed in 3 time periods; 1980-1989, n = 26, 1990-1999, n = 71 and 2000-2002, n = 44). Antegrade cerebral perfusion via subclavian cannulation, a more extensive resection as well as valvar repair was introduced as routine procedures from January 2000.

Results: Mortality and neurological complications decreased over time; from 31% to 9.1% and from 27% to 2.5%, respectively. During follow-up, 14 patients (12%) required surgical re-intervention for aneurysms (1 to 17 years later) with associated hospital mortality of 21%.

Conclusions: Antegrade cerebral perfusion reduces neurological complications and more extensive surgical approach did not increase mortality and morbidity.