| Summary: | Resumen: Introducción y objetivos: El síndrome aórtico agudo tipo A de Stanford tiene una incidencia de 3 casos/105 habitantes/año, y una mortalidad del 50% con tratamiento conservador y del 17-31% tras cirugía.Queremos analizar los factores predictivos de mortalidad hospitalaria, de supervivencia a largo plazo y reoperación en pacientes operados de forma emergente por síndrome aórtico agudo tipo A. Métodos: Entre noviembre de 1996 y diciembre de 2017 se intervinieron 193 pacientes, el 75,5% hombres, con una mediana de edad de 63 años (17-85). El 51,6% presentaba HTA, el 5,7% EPOC, el 3,6% intervención previa, el 24,9% derrame pericárdico severo y el 45,7% insuficiencia aórtica moderada-severa. Resultados: Realizamos reemplazo aislado de aorta ascendente en el 29,01%, asociado a raíz: 13,95%, al arco: 44,55%, a raíz y al arco: 6,22%, y arco y aorta descendente frozen elephant trunk: 6,22%. Dos (1,04%) pacientes murieron antes de iniciar la circulación extracorpórea.La mortalidad hospitalaria fue del 27,4%. De los 12 antecedentes analizados encontramos como predictores de mortalidad la HTA (OR = 2,2 [p = 0,017]) y la EPOC (OR = 7,5 [p = 0,001]).El tiempo medio de seguimiento de los 140 supervivientes (11 pacientes perdidos) fue de 151 ± 10 meses. La supervivencia a 1, 5 y 10 años es del 94%, 82% y 67%. La rotura de aorta fue la tercera causa de muerte a largo plazo (16,13% [n = 5]). No resultaron factores predictores de reoperación y mortalidad la insuficiencia aórtica severa ni la presencia de disección residual respectivamente. Conclusiones: Esta serie presenta una mortalidad hospitalaria similar a otros estudios y buena supervivencia a largo plazo. Se requiere un seguimiento estrecho de la aorta residual para la prevención de su rotura. Abstract: Introduction and objectives: Stanford type A acute aortic syndrome has an incidence of 3 cases/105 inhabitants/year, and has a mortality of 50% without treatment, and 17-31% after surgery.The purpose of this study is to analyse the predictive factors of in-hospital mortality, long-term survival, and reoperation in patients surgically operated on for type A acute aortic syndrome. Methods: Between November 1996 and December 2017, 193 patients were intervened of which 75.5% were men. The median age was 63 years (range 17-85). High blood pressure (HBP) was observed in 51.6% had HBP, with 5.7% chronic obstructive pulmonary disease (COPD), 3.6% a previous intervention, 24.9% severe pericardial effusion, and 45.7% moderate-severe aortic insufficiency. Results: Isolated replacement of ascending aorta was performed on 29.01%, associated to root replacement: 13.95%, to arch replacement in 44.55%, to root and arch replacement in 6.22%, and arch and descending aorta surgery “frozen elephant trunk “in 6.22%. Two (1.04%) patients died before starting extracorporeal circulation.Hospital mortality was 27.4%. Of the 12 personal backgrounds analysed, we found as mortality predictors the presence of HBP with an OR = 2.2 (P = .017) and COPD OR = 7.5 (P = .001).The mean follow-up time of the 140 survivors (11 lost patients) was 151 ± 10 months. Survival at 1, 5, and 10 years was 94%, 82%, and 67%, respectively. Aortic rupture was the third cause of long-term death in the long-term, 16.13% (n = 5).Neither severe aortic insufficiency nor the presence of residual dissection was predictive factors for reoperation. Conclusions: This sample shows a hospital mortality rate similar to other studies, as well as good long-term survival. Close monitoring of the residual aorta is required to prevent its rupture. Palabras clave: Síndrome aórtico agudo, Cirugía aórtica, Resultados, Seguimiento, Aorta, Keywords: Acute aortic syndrome, Aortic surgery, Outcomes, Follow-up, Aorta
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