Outcomes of patients who declined surgery for acute Stanford type A aortic dissection with patent false lumen of the ascending aorta.

OBJECTIVES: This study aimed to evaluate the outcomes of patients who did not undergo initial aortic surgery for acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta.

METHODS: Inpatient and outpatient records were retrospectively reviewed.

RESULTS: We identified 195 patients with acute type A aortic dissection with a patent ascending false lumen between January 1998 and March 2016. Of these, 137 underwent aortic surgery, 16 died before surgery and 42 declined aortic surgery. The ages of the patients who underwent and those who declined aortic surgery were 60.0 ± 10.6 years and 72.3 ± 12.4 years, respectively. The mortality rate of those who underwent and those who declined aortic surgery was 15 and 62% at 30 days and 19% and 67 at 90 days, respectively ( P  < 0.0001). In the 58 patients who did not undergo initial aortic surgery, the maximum aortic diameter was correlated with survival ( P  = 0.0037). At follow-up (3.7 ± 4.5 years; range 0-16.4 years), survival at 1, 5 and 10 years in those who underwent and those who declined initial aortic surgery was 78, 68 and 49%, and 29, 24 and 12%, respectively ( P  < 0.0001).

CONCLUSIONS: In this study of patients with acute Stanford type A aortic dissection with a patent false lumen of the ascending aorta, the mortality of those who declined initial aortic surgery was 62% at 30 days and 67% at 90 days, respectively, and a smaller aortic diameter was significantly associated with better survival.