Operative experience with 50 thoracic aortic dissections.

From 1971 to 1981, 46 patients were subjected to 50 operations (graft replacement, 31; patch aortoplasty, ten; suture aortorraphy, six; bypass, one; and nonthoracic vascular procedure, two) for thoracic aortic dissection. Four patients had two separate dissections. Dissections were classified as type A (ascending thoracic aortic, 38) or type B (descending thoracic aortic, 12) and subgrouped as acute (less than 2 weeks) or chronic (greater than 2 weeks). There were seven hospital deaths and an operative mortality of 14%. The operative mortality for acute type A dissections was 20% and for chronic type A, 7%. There was one operative death in the 12 type B dissections. Four of the seven deaths occurred in patients with an iatrogenic dissection. Overall cumulative survival was 70% at four years, but dropped to 45% at six years. Survival was poorest in the acute type A group and was only 38.9% at five years.