Medium-term survival after surgery for acute Type A aortic dissection is improving

Christian Olsson, Anders Ahlsson, Simon Fuglsang, Arnar Geirsson, Jarmo Gunn, Emma C Hansson, Vibeke Hjortdal, Kati Jarvela, Anders Jeppsson, Ari Mennander, Shahab Nozohoor, Anders Wickbom, Igor Zindovic, Tomas Gudbjartsson

34 Citationer (Scopus)

Abstract

OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries.

METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors ( n  = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI).

RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years (range 0-10.2 years). Survival was 95% (95% CI 93-96) at 1 year, 86% (95% CI 83-88) at 5 years and 76% (95% CI 72-81) at 8 years. Relative survival versus a matched normal population was 95% (95% CI 94-97) at 1 year, 90% (95% CI 87-93) at 5 years and 85% (95% CI 80-90) at 8 years. In multivariable analysis, increased age (HR 1.05 per year, 95% CI 1.04-1.07), previous abdominal or thoracic aortic repair (HR 3.2, 95% CI 1.6-6.4) and chronic renal disease (HR 2.7, 95% CI 1.2-6.2) were associated with increased medium-term mortality. Open distal anastomosis (HR 0.55, 95% CI 0.35-0.87) and operation in the 2010-2014 period (HR 0.90, 95% CI 0.83-0.97) were associated with decreased medium-term mortality.

CONCLUSIONS: Medium-term survival after acute Type A aortic dissection in the NORCAAD registry is satisfactory, close to a matched normal population and improved in the later part of the study period. The use of open distal anastomosis was associated with decreased medium-term mortality.

OriginalsprogEngelsk
TidsskriftEuropean Journal of Cardio-thoracic Surgery
Vol/bind52
Udgave nummer5
Sider (fra-til)852-857
Antal sider6
ISSN1010-7940
DOI
StatusUdgivet - 2017
Udgivet eksterntJa

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