Immediate Perioperative Results and Early Survival in Patients Undergoing Aortic Repair for Thoracic Acute Aortic Dissection: Risk Factors Analysis and Surgical Implications

Abstract

Emergent surgical repair of thoracic acute aortic dissection (TAAD) aims to prevent potentially lethal complications including cardiac tamponade, neurological damage, acute aortic valve dysfunction, rupture of the aortic wall into the pericardial space, or myocardial infarction due to the dissection of the coronary ostia. Furthermore, the progression of the dissection involving peripheral arteries with, consequently, a possible preoperative multiple-organ malperfusion can lead to a drastic increase in operative risk. In fact, even with prompt surgical treatment, TAAD continues to be associated with an in-hospital mortality rate of 20–30%, and malperfusion of various organ systems can dramatically increase the operative mortality. From the analysis of the various pre- and perioperative risk factors, it is possible to evaluate the real operative risk and establish in which patients emergency surgery continues to offer a substantial prognostic benefit in comparison with medical therapy only and in which surgery, on the contrary, may not offer any prognostic advantage.