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

The purpose of this study was to evaluate factors that impact outcome following repair of type A aortic dissection. Over 25 years (19842009), 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 beta-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 beta-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 beta-blocker therapy and decreased with improved SBP control. Strict control of hypertension with beta-blocker therapy is warranted following repair of acute type A dissection.