Predictors for Early Mortality after Surgery for Type A Aortic Dissection

Background: Early mortality after surgery for type A aortic dissection (ATAD) ranges between 16 and 37%. Thus, the aim of the study was to determine risk factors for early mortality in this cohort.

Method: Between January 2010 and February 2022, a total of 1,695 consecutive patients underwent aortic surgery at our center. Of these, 385 were operated on for ATAD. We retrospectively analyzed predictors for 30-day mortality using multivariable logistic regression analysis.

Results: Mean age was 63.7 ± 13.3 years (n = 131 >70 years) with 68.8% male patients. EuroSCORE II was 14.5 ± 14.5. Impaired renal function with GFR <60 mL/min was present in 21.6% (n = 83), reduced left ventricular function (LVEF <51%) in 25.2% (n = 97), and 10.6% (n = 41) suffered from heritable thoracic aortic disease (HTAD). Prior cardiac surgery had been performed in 6.8% (n = 26). ATAD was complicated by malperfusion and/or aortic rupture in 43.4% (n = 167) and 8.6% (n = 33) suffered an acute preoperative stroke.

Surgery on the aortic root was necessary in 22.9% (n = 88) and arch procedures were performed as hemiarch replacement in 65.7% (n = 253), conventional arch replacement in 10.9% (n = 42), and frozen elephant trunk procedure in 15.6% (n = 60). Concomitant coronary artery bypass grafting (CABG) was necessary in 10.4% (n = 40) of patients. Hypothermic circulatory arrest (HCA) and selective antegrade cerebral perfusion times were 41.6 ± 28.1 and 43.2 ± 34.3 minutes, respectively.

Thirty-day mortality was 19.7%. Multivariable logistic regression analysis revealed impaired renal function (OR: 3.03, 95% CI: 1.53–6.01), complicated ATAD (OR: 2.75, 95% CI: 1.41–5.35), concomitant CABG (OR: 3.33, 95% CI: 1.39–7.97), SACP >60 minutes (OR: 2.64, 95% CI: 1.33–5.23), and surgery on the aortic root (OR: 1.2.76, 95% CI: 1.25–6.10) as independent predictors for 30-day mortality. Presence of HTAD (OR: 0.09, 95% CI: 0.01–0.75) was independent predictor for lower 30-day mortality. Age >70 years, LVEF <51%, preoperative stroke, prior cardiac surgery, total aortic arch replacement, and HCA >55 minutes were not significantly associated with survival.

Conclusion: Aortic surgery for ATAD is still associated with high postoperative mortality rates. Especially patients with complicated ATAD, concomitant aortic root surgery, and CABG, as well as preoperatively impaired renal function and are at risk of high 30-day mortality, while redo and total arch surgery performed by experienced surgeons do not increase risk.

Publication History

Article published online:
28 January 2023