Outcomes after surgery for acute type A aortic dissection in “non-Marfan syndrome” patients with long life expectancy: A 24-year follow-up

Background Long-term survival and risk of reoperation in “non-Marfan syndrome” patients with a long life expectancy who undergo emergency surgery for acute type A aortic dissection (aTAAD) are not well known. Aim To analyse survival, risk of reoperation and quality of life in this population. Methods From 1990 to 2010, all patients aged ≤ 50 years and not affected by Marfan syndrome, who underwent emergency surgery for aTAAD at two institutions, were included in this analysis. Patients were categorized into four groups according to the extension of the aortic replacement: SUPRACORONARY, ROOT, ARCH and EXTENSIVE. Results Sixty-six patients (mean age 45 ± 4 years; range 34–50 years) were considered eligible for this analysis. Overall in-hospital mortality was 24% (16/66 patients); and 25%, 23%, 20.5% and 43% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Mean follow-up among survivors was 10.5 ± 7.2 years (range: 0.1–24.7 years). Overall 10-year survival was 55 ± 6%; and 75 ± 12%, 69 ± 13%, 47 ± 8% and 28 ± 17% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Overall freedom from reoperation on the aorta was 73 ± 7.5%; and 40 ± 20%, 75 ± 21%, 78 ± 8% and 100% in the SUPRACORONARY, ROOT, ARCH and EXTENSIVE groups, respectively. Conclusions In our experience, patients who underwent isolated supracoronary ascending aorta or root replacement showed the most satisfactory late survival. However, because the risk of reoperation is low when the replacement is extended to the root, our data suggest that root replacement could represent a good compromise between operative mortality and long-term survival.