Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases

Surgical treatment of type A acute aortic dissection remains a challenge, especially in elderly patients or in patients with a critical preoperative status. We have retrospectively assessed our series over a 15-year period starting in 1990, including patients operated under cardiac massage for preoperative cardiac arrest occurring in the operating room. There were 217 patients (mean age, 61.5+/-13.5 years; 16 patients >80 years). Preoperative shock was noted in 21.7%, including 14 patients operated under cardiac massage. Operating procedures were: modified Bentall (31%), aortic tube (67.1%), other (1.9%), aortic arch procedure in 26.4%. Overall mortality rate was 19.8% with an exponential increase with age (50% over 80 years). Of 14 patients operated under cardiac massage, three have been discharged: one ventricular fibrillation due to an acute myocardial infarction and two among the 13 with acute aortic ruptures in cardiac arrest (one being a redo, the adhesions limiting the tamponade). Our results confirmed age and preoperative shock prior to surgery as risk factors, and the fact that operating on a patient under cardiac massage for cardiac arrest due to an aortic rupture is probably not a reasonable therapeutic choice.