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

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.

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