Increasing complexity in aortic dissection reduces complications, improves outcomes—but mortality remains constant

When it comes to type A aortic dissection, cardiac surgeons have increasingly opted to perform more complex operations to reduce complications and improve postoperative care.

A study, published online June 6 in The Annals of Thoracic Surgery, examined cardiac surgeries from 2003 to 2015 to examine the association between a procedure’s complexity and risks faced by the patient.

“Type A aortic dissection requires emergency surgical repair,” said senior author Ravi K. Ghanta, MD, formerly of the University of Virginia in Charlottesville, now with Baylor College of Medicine in Houston. “This study shows that surgeons are adapting their surgical strategies to more aggressively treat aortic dissections, surprisingly, without additional upfront risk. Therefore, patients are benefiting from more extensive repair of aortic dissection, which may lead to improved long-term outcomes.”

For this study, Ghanta and colleagues reviewed records for 884 patients who underwent operations for acute type A aortic dissection from 2003 to 2015 in Virginia. Patients were grouped by when they underwent aortic dissection (309 were in the 2003-2009 group, 316 in 2009-2012 and 259 in 2013-2015). The median age of patients was 59 years.

Results showed the operations grew in complexity over time. Aortic root surgery (16 percent, 39 percent and 67 percent, respectively) and aortic arch repair (27 percent, 26 percent and 36 percent, respectively) were more common in the latest group.

Still, the mortality risk remained constant, at 19 percent, though risks for pneumonia and reoperation were significantly lowered.

“Surgeons are increasingly comfortable with performing more extensive repairs of the aorta and utilizing new surgical techniques, and they are doing so without increasing risk,” Ghanta said. “However, while the operative mortality numbers are lower than historical outcomes, 19 percent is still significant and further improvement is needed.”