Risk factors for long-term mortality after acute aortic dissection-results of the german registry for acute aortic dissection type a long-term follow-up.

OBJECTIVES: Several short-term analyses from German registry for acute aortic dissection type A (GERAADA) have been published. This study investigated whether short-term risk factors are transferable to the long-term prognosis of patients.

METHODS: 33 centers with 2686 patients participated in the long-term follow-up. 1164 patients died, 1063 survived and 459 were lost to follow-up during the follow-up timeframe (mean duration: 10.2 years). Long-term mortality of the cohort was compared with an age-stratified, German population.

RESULTS: One, five, and 10 years after initial surgery, the survival of the GERAADA patient cohort was 71.4%, 63.4% and 51%, respectively. Without the early deaths (90-day mortality 25.4%), survival was calculated after one, five, and 10 years: 95.6%, 83.5% and 68.3%.Higher age, longer extracorporeal circulation time, shorter perioperative ventilation time, and postoperative neurologic deficits were predictive of long-term prognosis. In an age-divided landmark analysis, the mortality of aortic dissection surgery survivors was found to be similar to that of the general German population. If patients are sorted in risk groups according to the GERAADA score, long-term survival differs between the risk groups.

CONCLUSIONS: If patients have survived an acute postoperative period of 90 days, life expectancy comparable to that of the general German population can be assumed in lower- and medium-risk patients. Whether the GERADAA score can provide valuable insights into the long-term prognosis of patients undergoing surgery for acute aortic dissection type A is still unclear.