Repair of acute type A aortic dissection: moving towards a more aggressive approach but keeping the old gold standards

In this issue of the European Journal of Cardiothoracic Surgery, Russo et al. [1] report the early and long-term results after surgery for type A acute aortic dissection (TA-AAD) in a retrospective multicentre study from seven different Italian referral centres. They included 1.148 consecutive patients surgically treated between 1981 and 2013. Their objective was to evaluate whether surgical treatment of TA-AAD has shown different clinical outcomes in the last decades in terms of in-hospital mortality, long-term survival and freedom from reoperation. The overall 30-day mortality rate was 25.7% and neurological impairment rate at discharge was 23% of the cases. In general terms, hospital mortality and stroke after TA-AAD repair, although reduced in the last two decades, still remain relatively high despite improvements in surgical approach, cerebral protection, and early and detailed diagnosis [2]. The authors identified that severe aortic regurgitation at the time of surgery was a significant risk factor for reintervention during the long (median 70 months) follow-up of hospital survivors. Cumulative survival rates from cardiac death were 95.3% at 5 years, 92.8% at 10 years and 52.8% at 20 years, respectively. The study is valuable for several reasons: