Importance of Blood Pressure Control After Repair of Acute Type A Aortic Dissection: 25-Year Follow-Up in 252 Patients

Authors

  • Spencer J. Melby MD,

    1. From the Division of Cardiothoracic Surgery at the University of Alabama at Birmingham, Birmingham, Alabama;
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  • Andreas Zierer MD,

    1. Division of Cardiothoracic Surgery at the Hospital of the Johann Wolfgang Goethe University, Frankfurt, Germany;
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  • Ralph J. Damiano Jr MD,

    1. Division of Cardiothoracic Surgery and the Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, Missouri
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  • Marc R. Moon MD

    1. Division of Cardiothoracic Surgery and the Center for Diseases of the Thoracic Aorta, Washington University School of Medicine, Barnes Jewish Hospital, St. Louis, Missouri
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Spencer J. Melby, MD, Division of Cardiothoracic Surgery, University of Alabama at Birmingham, 720 THT, 1530 3rd Avenue S, Birmingham, AL 35294
E-mail:melbys@uab.edu

Abstract

The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years (1984–2009), 252 patients underwent repair of acute type A dissection. Mean follow-up for reoperation or death was 6.9±5.9 years. Operative mortality was 16% (41 of 252). Multivariate analysis identified one risk factor for operative death: presentation malperfusion (P=.003). For operative survivors, 5-, 10-, and 20-year survival was 78%±3%, 59%±4%, and 24%±6%, respectively. Late death occurred earlier in patients with previous stroke (P=.02) and chronic renal insufficiency (P=.007). Risk factors for late reoperation included male sex (P=.006), Marfan syndrome (P<.001), elevated systolic blood pressure (SBP, P<.001), and absence of β-blocker therapy (P<.001). Kaplan-Meier analysis demonstrated at 10-year follow-up that patients who maintained SBP <120 mm Hg had improved freedom from reoperation (92±5%) compared with those with SBP 120 mm Hg to 140 mm Hg (74%±7%) or >140 mm Hg (49%±14%, P<.001). At 10-year follow-up, patients on β-blocker therapy experienced 86%±5% freedom from reoperation compared with only 57%±11% for those without (P<.001). Operative survival was decreased with preoperative malperfusion. Long-term survival was dependent on comorbidities but not operative approach. Reoperation was markedly increased in patients not on β-blocker therapy and decreased with improved SBP control. Strict control of hypertension with β-blocker therapy is warranted following repair of acute type A dissection.

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