A systematic approach to improve the outcomes of type A aortic dissection

Objectives: The aims of this study are to evaluate the outcomes and trends of contemporary emergency surgery for acute type A aortic dissection on the basis of a systematic approach and to assess the impact of temporary aortic crossclamping during systemic cooling on early and late outcomes. Methods: We retrospectively reviewed 702 consecutive patients who underwent emergency surgery for acute type A aortic dissection between March 2004 and May 2015. Our clinical protocol includes rapid transfer to the operating room, quick establishment of cardiopulmonary bypass, temporary aortic crossclamping during cooling, primary entry resection, and open distal anastomosis. We analyzed the perioperative data, survival, freedom from aortic reinterventions, and impact of aortic crossclamping on early and late outcomes. Results: The median time from hospital arrival to cardiopulmonary bypass establishment was 115 minutes and has decreased over the last decade (trend test P < .001). We perfused the femoral artery in 615 patients (87.6%), placed aortic crossclamping in 616 patients (87.7%), and performed open distal anastomosis in all patients. The operative mortality was 5.4% (38/702), and the incidence of stroke was 10.8% (76/702). The 7-year overall survival and freedom from aortic reinterventions were 80.4% and 87.5%, respectively. Compared with the non-clamping group, the crossclamping group had a shorter operation time, similar operative mortality, incidence of stroke, and freedom from aortic reinterventions. Conclusions: Emergency surgery for acute type A aortic dissection based on our systematic approach demonstrated excellent early and late outcomes. The temporary aortic crossclamping during cooling decreased the operation time without increasing early and late adverse events.