Background: Acute type-A aortic dissection is a surgical emergency. One unit's experience in the surgical repair of type-A aortic dissection is documented.
Methods: Surgical treatment was undertaken for type-A aortic dissection in 32 consecutive patients between January 1988 and August 1994 at Royal North Shore Hospital. Retrosternal chest pain was the commonest presenting symptom and in four of these cases it was initially misinterpreted as myocardial ischaemia.
Results: A total of 24 patients had signs of aortic incompetence on presentation. Computed tomography (CT) scanning was the commonest modality of definitive diagnosis, but trans-oesophageal echocardiography was used as confirmation wherever possible, and we now consider it the initial, best investigation whenever a diagnosis of dissection is considered. There were 15 supra-coronary ascending aortic replacements, and a further four with aortic valve re-suspension. There were 13 operations of the Bentall's type. The overall 30-day mortality was 19%. The late mortality was 19%, with 62% long-term survival at a mean follow-up of 4.8 years.
Conclusion: Early diagnosis and surgical intervention can give excellent palliation and improved life expectancy in acute type-A aortic dissection.