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Thorac Cardiovasc Surg 2021; 69(04): 322-328
DOI: 10.1055/s-0040-1710002
Original Cardiovascular

Risk Factors for Mortality in Acute Aortic Dissection Type A: A Centre Experience Over 15 Years

Mohamed Salem
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Christine Friedrich 
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Alexander Thiem
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Katharina Huenges
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Thomas Puehler
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Jochen Cremer
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
,
Assad Haneya
1   Department of Cardiovascular Surgery, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany
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Abstract

Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate and frequent postoperative complications. This study was designed to evaluate the risk factors for mortality in AADA patients.

Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between 2001 and 2016.

Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0 years 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)]. Intraoperatively, survivors had statistically shorter cardiopulmonary bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both groups. Postoperatively, the incidence of acute kidney injury (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 nonsurvivors. The multi-variable logistic regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI) were independent risk factors for mortality.

Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were considered risk factors for mortality.

Keywords

aorta/aortic - aortic valve and root - cardiopulmonary bypass - CPB


Publication History

Received: 02 September 2019

Accepted: 04 March 2020

Article published online:
19 June 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Antoine Legras, Matthieu Bruzzi, Kuniki Nakashima, Marie-Line Hillion, Daniel Loisance and Matthias Kirsch. Risk factors for hospital death after surgery for type A aortic dissection.
  • 2 Chiappini B, Tan ME, Morshuis W, Kelder H, Dossche K, Schepens M. Surgery for acute type A aortic dissection: is advanced age a contraindication?. Ann Thorac Surg 2004; 78 (02) 585-590
    CrossrefPubMedGoogle Scholar
  • 3 Stamou SC, Hagberg RC, Khabbaz KR. et al. Is advanced age a contraindication for emergent repair of acute type A aortic dissection?. Interact Cardiovasc Thorac Surg 2010; 10 (04) 539-544
    CrossrefPubMedGoogle Scholar
  • 4 Shrestha M, Khaladj N, Haverich A, Hagl C. Is treatment of acute type A aortic dissection in septuagenarians justifiable?. Asian Cardiovasc Thorac Ann 2008; 16 (01) 33-36
    CrossrefPubMedGoogle Scholar
  • 5 Caus T, Frapier JM, Giorgi R. et al. Clinical outcome after repair of acute type A dissection in patients over 70 years-old. Eur J Cardiothorac Surg 2002; 22 (02) 211-217
    CrossrefPubMedGoogle Scholar
  • 6 Mehta RH, O'Gara PT, Bossone E. et al International Registry of Acute Aortic Dissection (IRAD) Investigators. Acute type Aaortic dissection in the elderly: clinical characteristics, management, and outcomes in the current era. J Am Coll Cardiol 2002
    Google Scholar
  • 7 Olsson C, Thelin S, Ståhle E, Ekbom A, Granath F. Thoracic aortic aneurysm and dissection: increasing prevalence and improved outcomes reported in a nationwide population-based study of more than 14,000 cases from 1987 to 2002. Circulation 2006; 114 (24) 2611-2618
    CrossrefPubMedGoogle Scholar
  • 8 Ehrlich MP, Ergin MA, McCullough JN. et al. Results of immediate surgical treatment of all acute type A dissections. Circulation 2000; 102 (19, Suppl 3): III248-III252
    CrossrefPubMedGoogle Scholar
  • 9 Schoeneich F, Rahimi A, Eide M. et al. Transatrial left ventricular cannulation for arterial return in CABG with severe aortic calcification. Thorac Cardiovasc Surg 2012; •••: 60-PP60
    PubMedGoogle Scholar
  • 10 Griepp RB, Stinson EB, Hollingsworth JF, Buehler D. Prosthetic replacement of the aortic arch. J Thorac Cardiovasc Surg 1975; 70 (06) 1051-1063
    CrossrefPubMedGoogle Scholar
  • 11 Ueda Y, Miki S, Kusuhara K, Okita Y, Tahata T, Yamanaka K. Surgical treatment of aneurysm or dissection involving the ascending aorta and aortic arch, utilizing circulatory arrest and retrograde cerebral perfusion. J Cardiovasc Surg (Torino) 1990; 31 (05) 553-558
    PubMedGoogle Scholar
  • 12 Kazui T, Inoue N, Yamada O, Komatsu S. Selective cerebral perfusion during operation for aneurysms of the aortic arch: a reassessment. Ann Thorac Surg 1992; 53 (01) 109-114
    CrossrefPubMedGoogle Scholar
  • 13 David TE, Armstrong S, Ivanov J, Barnard S. Surgery for acute type A aortic dissection. Ann Thorac Surg 1999; 67 (06) 1999-2001 , discussion 2014–2019
    CrossrefPubMedGoogle Scholar
  • 14 Pansini S, Gagliardotto PV, Pompei E. et al. Early and late risk factors in surgical treatment of acute type A aortic dissection. Ann Thorac Surg 1998; 66 (03) 779-784
    CrossrefPubMedGoogle Scholar
  • 15 Ehrlich M, Fang WC, Grabenwöger M, Cartes-Zumelzu F, Wolner E, Havel M. Perioperative risk factors for mortality in patients with acute type A aortic dissection. Circulation 1998; 98 (19) II294-II298
    CrossrefPubMedGoogle Scholar
  • 16 Bachet J, Goudot B, Dreyfus GD. et al. Surgery for acute type A aortic dissection: the Hopital Foch experience (1977-1998). Ann Thorac Surg 1999; 67 (06) 2006-2009 , discussion 2014–2019
    CrossrefPubMedGoogle Scholar
  • 17 Moon MR, Sundt III TM, Pasque MK. et al. Does the extent of proximal or distal resection influence outcome for type A dissections?. Ann Thorac Surg 2001; 71 (04) 1244-1249 , discussion 1249–1250
    CrossrefPubMedGoogle Scholar
  • 18 Knipp BS, Deeb GM, Prager RL, Williams CY, Upchurch Jr GR, Patel HJ. A contemporary analysis of outcomes for operative repair of type A aortic dissection in the United States. Surgery 2008; 143 (02) 301
    CrossrefPubMedGoogle Scholar
  • 19 Boening A, Karck M, Conzelmann LO. et al. German Registry for Acute Aortic Dissection Type A: Structure, Results, and Future Perspectives. Thorac Cardiovasc Surg 2017; 65 (02) 77-84
    PubMedGoogle Scholar
  • 20 Miller DC, Mitchell RS, Oyer PE, Stinson EB, Jamieson SW, Shumway NE. Independent determinants of operative mortality for patients with aortic dissections. Circulation 1984; 70 (3 Pt 2, Suppl I): I153-I164
    CrossrefPubMedGoogle Scholar
  • 21 Sabik JF, Lytle BW, Blackstone EH, McCarthy PM, Loop FD, Cosgrove DM. Long-term effectiveness of operations for ascending aortic dissections. J Thorac Cardiovasc Surg 2000; 119 (05) 946-962
    CrossrefPubMedGoogle Scholar
  • 22 Neri E, Toscano T, Massetti M. et al. Operation for acute type A aortic dissection in octogenarians: is it justified?. J Thorac Cardiovasc Surg 2001; 121 (02) 259-267
    CrossrefPubMedGoogle Scholar
  • 23 Trimarchi S, Eagle KA, Nienaber CA. et al; International Registry of Acute Aortic Dissection Investigators. Role of age in acute type A aortic dissection outcome: report from the International Registry of Acute Aortic Dissection (IRAD). J Thorac Cardiovasc Surg 2010; 140 (04) 784-789 . Doi: 10.1016/j.jtcvs
    CrossrefPubMedGoogle Scholar
  • 24 McKneally MF. “We don't do that here”: Reflections on the Siena experience with dissecting aneurysms of the thoracic aorta in octogenarians. J Thorac Cardiovasc Surg 2001; 121 (02) 202-203
    CrossrefPubMedGoogle Scholar
  • 25 Zheng J, Lu S, Sun X. et al. Surgical management for acute type A aortic dissection in patients over 70 years-old. J Cardiothorac Surg 2013; 8: 78
    CrossrefPubMedGoogle Scholar
  • 26 Kawahito K, Adachi H, Murata S, Yamaguchi A, Ino T. Coronary malperfusion due to type A aortic dissection: mechanism and surgical management. Ann Thorac Surg 2003; 76 (05) 1471-1476 , discussion 1476
    CrossrefPubMedGoogle Scholar
  • 27 Di Eusanio M, Patel HJ, Nienaber CA. et al. Patients with type A acute aortic dissection presenting with major brain injury: should we operate on them?. J Thorac Cardiovasc Surg 2013; 145 (03) S213-21.e1
    CrossrefPubMedGoogle Scholar
  • 28 Di Eusanio M, Trimarchi S, Patel HJ. et al. Clinical presentation, management, and short-term outcome of patients with type A acute dissection complicated by mesenteric malperfusion: observations from the International Registry of Acute Aortic Dissection. J Thorac Cardiovasc Surg 2013; 145 (02) 385-390.e1
    CrossrefPubMedGoogle Scholar
  • 29 Lansman SL, McCullough JN, Nguyen KH. et al. Subtypes of acute aortic dissection. Ann Thorac Surg 1999; 67 (06) 1975-1978 , discussion 1979–1980
    CrossrefPubMedGoogle Scholar
  • 30 Kazui T, Washiyama N, Muhammad BA. et al. Extended total arch replacement for acute type a aortic dissection: experience with seventy patients. J Thorac Cardiovasc Surg 2000; 119 (03) 558-565
    CrossrefPubMedGoogle Scholar
  • 31 Piccardo A, Le Guyader A, Regesta T. et al. Octogenarians with uncomplicated acute type a aortic dissection benefit from emergency operation. Ann Thorac Surg 2013; 96 (03) 851-856
    CrossrefPubMedGoogle Scholar