Nimesh D. Desai MD PHD, Alberto Pochettino MD, Wilson Szeto MD, William Moser RN, Kanika Gupta BA, Patrick Moeller BA, Joseph E. Bavaria MD Hospital of.

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Nimesh D. Desai MD PHD, Alberto Pochettino MD, Wilson Szeto MD, William Moser RN, Kanika Gupta BA, Patrick Moeller BA, Joseph E. Bavaria MD Hospital of the University of Pennsylvania

 Perioperative mortality of surgery for acute Type A Aortic Dissection(TAD) is reported to be over 25% in large registries.  We present a large, long-term experience with repair of TAD in high risk patients presenting with advanced age, hemodynamic compromise and malperfusion.

 Between 1993 and 2009, we performed 490 emergent repairs for acute TAD. 55.7% (273/490) of patients had at least one high risk feature:  High Risk Features: age>80, Malperfusion, hemodynamic compromise  Data was abstracted from a large prospective database with annual follow-up and death index linkage. Standard univariate, survival and regression methodologies were utilized

64% of patients underwent aortic valve resuspension, 12% AVR with ascending replacement and 24% underwent root replacement. Distal anastomoses were performed open under circulatory arrest conditions with either retrograde or antegrade perfusion. 5% of patients had connective tissue disorders and another 7% were bicuspid.

%

 Higher acuity patients with acute type A aortic dissection experience poorer outcomes.  However, in a wide variety of patients, repair can be performed with acceptable mortality. Investigation of strategies to mitigate the effect of malperfusion and late reoperation on the distal segment is warranted.