Prognosis after non-surgical therapy for acute type A aortic dissection.

BACKGROUND

Immediate surgery to save life is the recommended treatment for Stanford type A acute aortic dissection (AAAD).

METHOD: The present study comprised 35 patients admitted with AAAD who were considered inappropriate candidates for surgery or declined surgery. The mean age was 84.5 ± 9.6 years. Eight patients who were considered inappropriate candidates for surgery due to severe stroke in 2 patients or hemodynamic instability in 6. Twenty-seven patients aged 88.0 ± 5.9 years who declined surgery, predominantly due to advanced age.

RESULTS

The overall in-hospital mortality was 51.4%. Mortality among patients that declined surgery or were considered inappropriate candidates for surgery were 37% and 100%, respectively. Causes of death among patients that declined surgery were cardiac tamponade in 6 and aortic rupture in 4. Mid-term survival among patients who refuse surgery, including in-hospital death, were 51.6 ± 10% and 34.5 ± 10%, on the other hand, Mid-term survival in hospital survivors were 81.9 ± 9% and 54.8 ± 14%. The causes of death among the discharged patients were senility in three, malignant tumor in two, pneumonia, aortic rupture, and unknown cause in one each.

CONCLUSIONS

Mortality from AAAD is 51.4%, including inappropriate candidates for surgery. When patients were evaluated as suitable candidates for surgical intervention but subsequently refused the surgical procedure, in-hospital mortality was 37%. Long-term survival of hospital survivor was acceptable. These data can be a benchmark for patient and patient's family to select medical therapy for AAAD in consideration with the patient's will.