Perioperative risk factors for mortality in patients with acute type A ‎aortic dissection : A retrospective analysis of a center experience ‎over 15 years

‎Background Acute type A aortic dissection (AAAD) isassociated with highmortality rateandfrequent ‎postoperative complications. This study was designed to evaluate perioperative risk ‎factors for mortality in patients with AAAD.‎ Patients and methods A retrospective analysis included 344 consecutivepatientswho underwent surgery for ‎AAAD in moderate hypothermic circulatory arrest (20-24 C°) between 2001 and 2016.‎ Results ‎ The 30-day mortality rate for all patients was 18%. Non-survivors were significantly ‎older (65.7±12.0years vs.62.0±12.5 years; p=0.034) with significantly higher Euro-score ‎II [15.4%(6.6;23.0) vs. 4.63%(2.78;9.88) p<0.001).Univariante analysis revealed several ‎preoperative factors that were found to be statistically significant predictors for 30-day ‎mortality: older age (>75years), coronary heart disease, previous cardiac surgery and ‎preoperative cardiopulmonary resuscitation (CPR) (p<0.05). Intraoperatively, survivors ‎had statistically shorter cardiopulmonary bypass times [163min (134;206) vs. 198 min ‎‎(150;245); p=0.001]. However, the hypothermic circulatory arrest time was similar ‎between the groups. Postoperatively, the incidence of AKI (55.9% vs. 15.2%; p<0.001), ‎stroke (27.9% vs. 12.1%; p=0.002) and sepsis (18.0% vs. 2.1%; p<0.001) were ‎significantly higher among non-survivors. The multiple logistic regression confirmed ‎that older age, previous cardiac surgery, preoperative CPR, intraoperative transfusion ‎and postoperative AKI were statistically significant independent risk factors for death ‎‎(p<0.05).‎ Conclusion The currentstudy suggested that AAADremains associated with a high mortality rate. ‎The reason for mortality and complications in patients undergoing surgical repair of ‎AAAD was multifactorial, especially older age, previous cardiac surgery, preoperative ‎CPR, transfusion, as well as postoperative AKI were considered risk factors for ‎mortality.‎


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