Aortic dissection: half of patients who survived surgery lived for 10 years.

Clinical bottom line (level 4)

  1. 50% of patients who survived surgery for aortic dissection, survived for a further 10 years, though a quarter needed further surgery.
  2. Patients were at increased risk of mortality with:
    • stroke
    • renal dysfunction
    • operation date
    • MI
    • surgery at a younger age
    • site of tear (ascending aorta < descending aorta < aortic arch)
    • tamponade
Haverich et al: Circulation 1985; 72 (II): II-22-II-33
Expires December 2004

The study

Case series with ?objective ?blinded outcomes, adjusted for confounding factors, not validated in an independent set of patients.

Setting: university hospital, USA

135 patients (aged range 15 to 86 years; mean 56, ?% male) patients who survived having surgery for acute or chronic (symptoms for more than 14 days) aortic dissection, from 1963-82.


Multivariate analysis was performed on confounding factors.

?100% followed for mean 10 years
Outcomes studied:
  • 69% of patients were type A
  • 47% of patients had hypertension; 10% had Marfan's syndrome

The evidence


  • survival:
    • at 5 years: 79% +/- 4
    • at 10 years: 53% +/- 7
  • re-operations:
    • at 5 years: 13% +/- 4
    • at 10 years: 23% +/- 6
  • There was no difference between any groups.
  • Multivariate analysis of risk factors found the following to be independently correlated with mortality:
    • stroke
    • renal dysfunction
    • site of tear (ascending aorta < descending aorta < aortic arch)
    • tamponade
    • operation date
    • myocardial infarction
    • surgery at a younger age

Comments

  1. Study took place over many years- techniques changed and operative survival improved. How valid does this make the conclusions and multivariate analysis?
  2. ORs/ RRs were not given.
  3. The patients were followed up from the original study by Miller et al in 1984, where operative mortality was studied.

Citation

  1. Haverich A, Miller DC, Scott WC, et al: Acute and chronic aortic dissections- determinants of long-term outcome for operative survivors. Circulation 1985; 72 (II): II-22-II-33
Contributor: Chris Ball and Clare Wotton, December 2000
Reviewer:

Clinical Question.
Patient aortic dissection
Intervention or Exposure prevalence
Outcome long term mortality after operation