Survival outcomes after surgery for type-a aortic dissection: a contemporary Dutch nationwide registry study

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Abstract
OBJECTIVES: To describe the nationwide survival outcomes after surgery for type-A dissection (TAAD). METHODS: All patients who underwent surgery for TAAD in the Netherlands between 2018 and 2021 were identified in the Netherlands Heart Registration (NHR) database. The NHR data were linked to lifelong survival data from Statistics Netherlands (98% match). Time trends for in-hospital and mid-term mortality were described, and age- and sex-adjusted regression analysis was performed. The cause and location of death were reported and stratified according to survival time intervals. RESULTS: The study population consisted of 1317 patients with a mean age of 63.1 years (11.8). The number of surgeries increased from 284 in 2018 to 375 in 2021. The surgery included the ascending aorta in 99%, aortic arch in 73%, aortic root in 32.5% and the descending aorta in 5% of cases. In-hospital mortality decreased from 20.4% in 2018 to 13.9% (95% CI) in 2021. A total of 318 deaths were recorded and the majority (70%) of patients died from the consequences of their dissection. However, among 365-day survivors, only 14% died related to their dissection, while 37% of deaths were related to cardiovascular disease and 17% to cancer. The majority (84%) of patients died in the hospital but deaths after 365 days occurred most frequently (37%) at home. CONCLUSIONS: Over the recent years, the number of surgeries for type-A dissections in the Netherlands has increased and in-hospital mortality has decreased. For patients surviving one year after surgery, the main cause of death was not dissection, but other causes such as cardiovascular disease or cancer.

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