Objective : To study the population, diagnosis and clinical outcome after acute surgery for ascending aorta dissection.
Methods and Patients : From 1986 through 1997, 61 patients underwent urgent surgery for acute aortic dissection in our hospital. Age ranged from 17 to 75 years, 82% were males. Arterial hypertension (62%), Marfan Syndrome (8%) and previous aortic valve replacement (10%) were the most important preoperative risk factors. A miscellaneous degree of cardiogenic shock was present
in 43%. Diagnosis was made through TEE, CT, Angio, MRI or a combination. Followup by means of CT/MRI investigation and/or direct patient contact was complete in all cases.
Results : A DeBakey type I dissection was found in 77%, in 4 patients the dissection was limited to the ascending aorta and arch, 6 had a DeBakey type II. Angio reached a 100% sensitivity, but an investigation related complication was present in 11 %. MRI also reached 100%, TEE 92% and CT 72%.
A Bentall repair (49%) or a graft interposition (47,5%) was combined with an arch replacement in 25%. Revision for bleeding or tamponade (18%) and neurologic dysfunction (20%) were the two most common postoperative complications.
In hospital mortality was 23% (all DeBakey type I dissections in cardiogenic shock with an arch replacement in 36%).
Actuarial 5 and 10 year survival was 62 + 8%. Late mortality was 11,5% of which an aorta related complication was the cause in only 1 case. CT/MRI investigation showed a persistent false lumen in 60% and an aneurysmal dilatation in 45% of the hospital leavers. Reintervention rate was 15% (aneurysmal dilatation in 55%).
Conclusions : TEE is the best diagnostic non-invasive, low time consuming investigation in this unstable group. The early clinical outcome depends largely on the preoperative patient condition, extend of dissection and consecutive repair. The distal false lumen persists in the majority of cases without major implications but the aneurysmal dilatation delineates largely the reintervention rate and indicates the need of life-long radiological follow-up.