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Medium-term survival after surgery for acute Type A aortic dissection is improving

Olsson, Christian; Ahlsson, Anders; Fuglsang, Simon; Geirsson, Arnar; Gunn, Jarmo; Hansson, Emma C.; Hjortdal, Vibeke; Jarvela, Kati; Jeppsson, Anders and Mennander, Ari, et al. (2017) In European Journal of Cardio-thoracic Surgery 52(5). p.852-857
Abstract

OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries. METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors (n = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years... (More)

OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries. METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors (n = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years (range 0-10.2 years). Survival was 95% (95% CI 93-96) at 1 year, 86% (95% CI 83-88) at 5 years and 76% (95% CI 72-81) at 8 years. Relative survival versus a matched normal population was 95% (95% CI 94-97) at 1 year, 90% (95% CI 87-93) at 5 years and 85% (95% CI 80-90) at 8 years. In multivariable analysis, increased age (HR 1.05 per year, 95% CI 1.04-1.07), previous abdominal or thoracic aortic repair (HR 3.2, 95% CI 1.6-6.4) and chronic renal disease (HR 2.7, 95% CI 1.2-6.2) were associated with increased medium-term mortality. Open distal anastomosis (HR 0.55, 95% CI 0.35-0.87) and operation in the 2010-2014 period (HR 0.90, 95% CI 0.83-0.97) were associated with decreased medium-term mortality. CONCLUSIONS: Medium-term survival after acute Type A aortic dissection in the NORCAAD registry is satisfactory, close to a matched normal population and improved in the later part of the study period. The use of open distal anastomosis was associated with decreased medium-term mortality.

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published
subject
keywords
Aortic dissection, NORCAAD, Open distal anastomosis, Outcomes, Survival
in
European Journal of Cardio-thoracic Surgery
volume
52
issue
5
pages
6 pages
publisher
Elsevier
external identifiers
  • scopus:85034078450
  • wos:000414364600004
ISSN
1010-7940
DOI
10.1093/ejcts/ezx302
language
English
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yes
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4e55e69d-ffd8-4d93-bccc-417850edbd73
date added to LUP
2017-12-28 12:12:25
date last changed
2018-03-30 03:00:15
@article{4e55e69d-ffd8-4d93-bccc-417850edbd73,
  abstract     = {<p>OBJECTIVES: To report long-term survival and predictors of mortality in patients included in a large, contemporary, multicentre, multinational database: Nordic Consortium for Acute Type A Aortic Dissection (NORCAAD), which consists of 8 centres in 4 Nordic countries. METHODS: Currently, NORCAAD includes 1159 patients operated between 2005 and 2014. In 30-day survivors (n = 955, 82%), the Kaplan-Meier and Cox proportional hazard methods were used to analyse medium-term (up to 8 years) survival and relative survival versus a matched normal population. Pre- and intraoperative predictors were expressed as hazard ratio (HR) with 95% confidence interval (95% CI). RESULTS: Cumulative follow-up was 3514 patient-years with a median of 3.2 years (range 0-10.2 years). Survival was 95% (95% CI 93-96) at 1 year, 86% (95% CI 83-88) at 5 years and 76% (95% CI 72-81) at 8 years. Relative survival versus a matched normal population was 95% (95% CI 94-97) at 1 year, 90% (95% CI 87-93) at 5 years and 85% (95% CI 80-90) at 8 years. In multivariable analysis, increased age (HR 1.05 per year, 95% CI 1.04-1.07), previous abdominal or thoracic aortic repair (HR 3.2, 95% CI 1.6-6.4) and chronic renal disease (HR 2.7, 95% CI 1.2-6.2) were associated with increased medium-term mortality. Open distal anastomosis (HR 0.55, 95% CI 0.35-0.87) and operation in the 2010-2014 period (HR 0.90, 95% CI 0.83-0.97) were associated with decreased medium-term mortality. CONCLUSIONS: Medium-term survival after acute Type A aortic dissection in the NORCAAD registry is satisfactory, close to a matched normal population and improved in the later part of the study period. The use of open distal anastomosis was associated with decreased medium-term mortality.</p>},
  author       = {Olsson, Christian and Ahlsson, Anders and Fuglsang, Simon and Geirsson, Arnar and Gunn, Jarmo and Hansson, Emma C. and Hjortdal, Vibeke and Jarvela, Kati and Jeppsson, Anders and Mennander, Ari and Nozohoor, Shahab and Wickbom, Anders and Zindovic, Igor and Gudbjartsson, Tomas},
  issn         = {1010-7940},
  keyword      = {Aortic dissection,NORCAAD,Open distal anastomosis,Outcomes,Survival},
  language     = {eng},
  month        = {11},
  number       = {5},
  pages        = {852--857},
  publisher    = {Elsevier},
  series       = {European Journal of Cardio-thoracic Surgery},
  title        = {Medium-term survival after surgery for acute Type A aortic dissection is improving},
  url          = {http://dx.doi.org/10.1093/ejcts/ezx302},
  volume       = {52},
  year         = {2017},
}