Aortic dissection: most patients survived surgery.

Clinical bottom line (level 4)

  1. A quarter of patients with aortic dissection operated on between 1963 and 1982 died operatively.
  2. A tenth of patients operated on between 1977 and 1982 died.
  3. Patients were at increased risk of mortality with:
    • renal dysfunction
    • renal/ visceral insufficiency
    • site of tear
    • tamponade
    • operation date
    • pulmonary disease
Miller et al: Circulation 1984; 70 (I): I-153-I-163
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

175 patients (aged range 15 to 86 years; mean 56, ?% male) 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 perioperative
Outcomes studied:
  • operative mortality 1963-82
  • operative mortality 1977-82

    • 69% of patients were type A
    • 47% of patients had hypertension; 10% had Marfan's syndrome

    The evidence

    outcome time to outcome number of patients/total number %
    (95% CI)
    operative mortality 1963-82 perioperative 40/175 23%
    (17% to 29%)
    operative mortality 1977-82 perioperative / 9.0%
    (% to %)

    • 28% of deaths were due to cardiac events (MI or ventricular tachycardias). 35% due to aortic complications (haemorrhage or rupture).
    • Multivariate analysis of risk factors found the following to be independently correlated with mortality:
      • renal dysfunction (serum creatinine > 3 mg/ dl or blood urea nitrogen > 40 mg/ dl)
      • renal/ visceral insufficiency
      • site of tear (ascending aorta < descending aorta < aortic arch)
      • tamponade
      • operation date
      • pulmonary disease (diagnosed and/ or treated for any chronic lung ailment)

    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. See Haverich et al 1985 CAT for long term outcomes.

    Citation

    1. Miller DC, Mitchell RS, Oyer PE, et al: Independent determinants of operative mortality for patients with aortic dissections. Circulation 1984; 70 (I): I-153-I-163
    Contributor: Chris Ball and Clare Wotton, December 2000
    Reviewer:

    Clinical Question.
    Patient aortic dissection
    Intervention or Exposure prevalence
    Outcome operative mortality