SURGICAL REPAIR OF TYPE-A AORTIC DISSECTION - EARLY AND LATE RESULTS IN 32 CONSECUTIVE PATIENTS

Background: Acute type-PI aortic dissection is a surgical emergency. O ne unit's experience in the surgical repair of type-St aortic dissecti on is documented. Methods: Surgical treatment was undertaken for type- a aortic dissection ill 32 consecutive patients between January 1988 a nd August 1994 at Royal North Shore Hospital. Retrosternal chest pain was the commonest presenting symptom and in four of these cases it was initially misinterpreted as myocardial ischaemia.Results: A total of 24 patients had signs of aortic incompetence on presentation. Computed tomography (CT) scanning was the commonest modality of definitive dia gnosis, but trans-oesophageal echocardiography was used as confirmatio n wherever possible, and we now consider it the initial. best investig ation whenever a diagnosis of dissection is considered. There were 15 supra-coronary ascending aortic replacements, and a Further four with aortic valve re-suspension, There were 13 operations of the Bentall's type. The overall 30-day mortality was 19%. The late mortality-was 19% , with 62% long-term survival at a mean follow-up of 4.8 years, Conclu sion: Early diagnosis and surgical intervention fan give excellent pal liation and improved life expectancy in acute type-A aortic dissection .