Acute Type A Aortic Dissection: Pre-Operative Clinical and Radiological Predictors of Outcome

Abstract
Background: Acute type A aortic dissection is a surgical emergency associated with high morbidity and mortality and is still a surgical challenge. The aim of our work is to evaluate the impact of pre-operative clinical status of different malp-erfusion symptoms (according to Penn classification) and radiological findings on surgical outcome of acute type A dissection patients.
Aim of Study: Is to report our experience in surgical management of acute type A dissection patients and to deter-mine the impact of pre-operative ischaemia (by Penn class) on post-operative outcome.
Patients and Methods: Between January 2012 and De-cember 2014, 30 patients (23 males, 7 females) with acute type A aortic dissection were operated upon at Kasr Al-Aini Cardiac Surgery Unit, Cairo University. All patients presented with severe chest pain and pulse deficit. Their age ranged from 30 to 70 years. 2 patients had bicuspid aortic valve and 8 patients had Marfan syndrome. 3 patients had acute lower limb ischemia, 6 had renal malperfusion and 4 had massive pericardial effusion. All patients had pre-operative multislice CT aortography with 4 patients showing extensive arch tears and 4 patients had dissected coronary arteries on multislice CT of the coronaries. 13 patients had supracoronary conduit replacement of ascending aorta, 13 had modified Bentall operation, and 4 had valve-sparing (David) operation. All patients had circulatory arrest at moderate hypothermia and cerebral protection for open repair of the dissected aortic arch.
Results: The mean cross clamp time was 145±25minutes, and total circulatory arrest time was 25±10 minutes. Patients with pre-operative malperfusion had more prolonged and complicated post-operative stay. There was 5 (17%) post-operative mortality: 1 due to massive bleeding, 2 due to prolonged ventilation following stroke, 1 due to hepato-renal failure and 1 due to myocardial failure.
Conclusion: Surgical treatment of acute type A aortic dissection is challenging and requires a well-planned strategy to get optimum outcome.
Dissection patients with malperfusion syndromes, circum-ferential arch tears, and dissected coronaries carry higher risk of mortality.