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Eur J Cardiothorac Surg 2002;22:59-63
© 2002 Elsevier Science NL

Predictors of complications in acute type B aortic dissection

^a Clinic of Cardiac Surgery, University Hospital Zurich, Zurich, Switzerland
^b Department of Biostatistics, University of Zurich, Zurich, Switzerland

Received 13 September 2001; received in revised form 7 March 2002; accepted 22 March 2002.

* Corresponding author. Division of Cardiac Surgery, Triemli Hospital, 8063 Zurich, Switzerland. Tel.: +41-1-466-1111; fax: +41-1-466-2745
e-mail: michele.genoni{at}triemli.stzh.ch

Objectives: Medical treatment is generally advocated for patients with acute type B aortic dissection without complications. The objective of this retrospective analysis was to determine whether there are any initial findings that can help predict the long-term course of the disease. Methods: Case records of the 130 patients treated for type B aortic dissection between 1988 and 1997 were reviewed; 41 (31%) were operated on in the acute phase (<14 days), 31 (24%) were operated on in the chronic phase and 58 (45%) were treated medically. Results: Overall acute mortality was 10.8%; 22% for patients operated on in the early phase and 5.6% for medically treated patients. Age (P=0.002), persistent pain (P=0.01) and malperfusion (P=0.001) were significant independent predictors of the need for surgery. Paraplegia/para paresis (P=0.0001), leg ischaemia (P=0.003), pleural effusion (P=0.003), rupture (P=0.0001), shock (P=0.0001), age (P=0.003), cardiac failure (P=0.002) and aortic diameter >4.5 cm (P=0.002) were significant predictors of poor survival. Age and shock also emerged as independent risk factors. Patients without malperfusion (P=0.0001), pleural effusion (P=0.003), rupture (P=0.0001) and shock (P=0.0001) had a significantly better event-free survival (freedom from repeat surgery and death). The actuarial survival rate for high-risk patients (malperfusion, rupture, shock) was 62% at 1 year and 40% at 5 years; the corresponding values for low-risk patients were 94 and 84%, respectively. Conclusions: Rupture, shock and malperfusion are significant predictors of poor survival in patients with acute type B aortic dissection.

Key Words: Acute type B aortic dissection • Survival • Mortality • Predictors

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