PURPOSE: To review the management of @entity1 with acute @entity1580 . METHODS: Between June 1967 and December 2003, 246 @entity1 (151 males and 95 females, 20-82 years; median 59 years) underwent operation for type A dissection. Early mortality and @entity1580 -related late events (reoperation and @entity204 related to @entity1580 ) were assessed and correlated with the surgical approach. RESULTS: Over 37 years, early mortality has markedly improved, 50% in 1970s, 22% in 1980s, 17% in 1990s, and 11% after 2000. However, late @entity204 occurred at a constant rate, overall late survival at 10 and 20 years were 59% and 9%, respectively, and this did not improve after the 1990s. Preoperative hemodynamic instability, @entity296 , smoking history, prolonged bypass and cross-clamp time, and year of surgery were found to be risk factors for @entity204 . The main cause (21%) of late @entity204 was @entity1580 -related events, especially in the distal aorta. However, no intraoperative risk factors were found to be predictive of late dissection-related events. Surgical techniques including complete resection of the intimal tear or distal extent of the surgery had no impact on late distal event-free survival. CONCLUSION: Despite improvement of short-term outcome over 37 years, @entity1 who had @entity1580 are still living with elevated risk of @entity204 . Although late events in the distal aorta were a major risk, aggressive surgical approaches did not improve these outcomes. Vigilant follow-up is necessary for these @entity1 .

Surgery for acute type a XXXX a 37-year experience in Green Lane Hospital.

@entity1 :: ('9606', 'Species') :: ['patients'] @entity296 :: ('MESH:D009202', 'Disease') :: ['myocardial and kidney malperfusion'] @entity204 :: ('MESH:D003643', 'Disease') :: ['early death', 'death', 'deaths'] @entity1580 :: ('MESH:C562834', 'Disease') :: ['aortic dissection', 'type A aortic dissection']
@entity1580 :: (MESH:C562834,Disease) :: ['aortic dissection']
