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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