Outcome after Surgery for Type A Aortic Dissection in Patients with Preoperative Invasive Mechanical Ventilation

Background: Several conditions associated with type A aortic dissection may require preoperative invasive mechanical ventilation (IMV). The current literature lacks data on the prevalence and postoperative outcomes of this subset of patients. Thus, this study aims to investigate these unexplored issues in a large European registry.

Methods: Data were retrieved from the multicenter European Registry of Type A Aortic Dissection (ERTAAD). Bootstrapped LASSO (Least Absolute Shrinkage and Selection Operator) logistic regression was performed for variable (feature) selection to identify key predictors of hospital death and remove non-predictive variables. In the second step, a multilevel multivariate logistic regression (MMLR) was performed given the clustered (multicenter) structure of data. Cox regression analysis including only discharged patients was performed to explore differences between IMV and non-IMV patients after discharge.

Results: A total of 346 (9.26%) out of 3,735 patients required preoperative IMV. Compared with the non-IMV patients, patients requiring IMV were older (67 vs. 64 years, p = 0.02) and had worse preoperative hemodynamic conditions as testified by the higher rate of preoperative cardiac massage and cardiogenic shock requiring inotropes (20% vs. 3%, 50% vs. 14%, p < 0.001). Patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, p < 0.001) and significantly higher proportion of tear in the aortic root (p = 0.048). The mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p < 0.001). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared with the remaining patients. IMV yielded the highest odds in the model prediction for in-hospital mortality (OR 2.35, CI 1.64 to 2.20, p < 0.001). After discharge, IMV patients did not show significantly worse long-term survival than non-IMV patients (p = 0.84).

Conclusion: Invasive mechanical ventilation before type A aortic dissection surgery is not infrequent. The in-hospital mortality rate of patients with preoperative invasive mechanical ventilation was more than twice that of non-ventilated patients. The baseline profile and postoperative mortality risk of this subset of patients should possibly urge surgeons to tailor the surgical strategy more appropriately to improve the immediate outcome.

NB: This abstract was presented in a similar form at a previous meeting.

Publication History

Article published online:
11 February 2025