Clinical characteristics and outcomes of subacute/chronic type A aortic dissection: A multi-center retrospective cohort study

Objective: Few studies have investigated the outcomes of subacute/chronic type A aortic dissection (TAAD). In this study, we presented the clinical characteristics and outcomes associated with subacute/chronic TAAD. Methods: This is a multicenter retrospective observational study that enrolled 288 patients with subacute/chronic TAAD who underwent aortic surgery at eight centers from January 2015 to 2019. Logistic regression and random forest analyses were performed to identify predictors and their respective impacts on prognoses. Results: 30-day mortality in patients with subacute/chronic TAAD was 12 (4.2%). After a median follow-up of 39.7 (interquartile range 14.9–53.2) months, the overall survival of the entire cohort was 91.2%, 88.8%, and 86.8% at 1, 3, and 5 years, respectively. The cardiopulmonary bypass time was a significant independent risk factor for mortality, and the risk of mortality increased when the maximum ascending aorta diameter exceeded 55 mm or the left ventricular ejection fraction (LVEF) was less than 58%, according to the random forest regression. Conclusions: The reduced preoperative cardiac function and increased maximum ascending aorta diameter in subacute/chronic TAAD are associated with a higher risk of postoperative mortality. Early surgical treatment may be beneficial for these patients.