Associazione Nazionale Medici Cardiologi Ospedalieri



Surgery of Type A Aortic dissections: what has changed? Single center experience

Fiorentino Maria Francesca Cotignola(Ravenna) – Maria Cecilia Hospital GVM | Mikus Elisa Cotignola(Ravenna) – Maria Cecilia Hospital GVM | Calvi Simone Cotignola(Ravenna) – Maria Cecilia Hospital GVM


Our knowledge on type A aortic dissection (ATAAD) has evolved, and there are some differences in surgical approach. In this paper, we focused on what changed in the surgical treatment of ATAAD and on the impact of these changes on patients’ survival, analyzing our center experience and comparing it with literature latest evidences.

Materials and methods

From 2010 to 2022, 342 consecutive patients underwent surgery for Acute Type A Aortic dissection at our institution. In order to identify changes in these patients’ management over time, we divided our population in two groups according to the year of surgery: Group A before 2016 (146 patients) and Group B after 2016 (196 patients).


Patients from Group B (after 2016) showed more comorbidities and a worse clinical presentation than patients from Group A (chronic kidney disease 9.2% vs 2.1% p=0.006, neurological deficit on admission 8.7% vs 0% p < 0.001, cardiac tamponade 12.2% vs 0.7% p < 0.001, and pre-operative catecholamine support 4.1% vs 0% p=0.012). Also of pre-operative malperfusion was more frequent (coronary 6.6% vs 0% p < 0.001 and peripheral 6.6% vs 0% p < 0.001). In Group B in 70.4% of the population the circulatory arrest with antegrade selective cerebral perfusion was used vs 30.8% in Group A (p < 0.001) and we find a bigger percentage of emiarch replacement (43.4% vs 23.3% P=0.008) and total arch replacement (27% vs 13.7% p=0.017) than in Group A. In-hospital mortality resulted to be 10.2% with no differences between the groups. Neurological events (0.001) and post-operative dialysis (p=0.036) were more frequent in Group B. On the other hand, in Group A post-operative cardiac tamponade (9.65 vs 3.1% p=0.007) and red blood cells transfusions were higher. Conclusions Nowadays surgery is performed on more critical patients with higher surgical risk and the tendency is to perform more complex operations with replacement of a largest portion of the diseased aorta in order to reduce reintervention rate. Recently, clinical studies and guidelines highlighted the importance of creating a multidisciplinary aortic team to discuss and manage these patients in order to assure the best treatment options to each patient and to reduce mortality and morbidity.