in type A acute aortic dissection: a single study from China
Hongliang Yuan1,2#, MD, Yuman
Li1,2#, MD, PHD, Wenqian Wu1,2, MD,
PHD, Yongxing Zhang1,2, MD, Manwei
Liu1,2, MD, PHD, Mingxing Xie1,2*,
MD, PHD
Department of Ultrasound, Union Hospital, Tongji Medical College,
Huazhong University of Science and Technology, Wuhan 430022, China;
Hubei Key Laboratory of Molecular Imaging, Union Hospital,Tongji
Medical College, Huazhong University of Science and Technology, Wuhan
430022, China.
#Drs Yuan and Li contributed equally to this work.
Corresponding Author:
Mingxing Xie, MD, PhD; Department of Ultrasound, Union Hospital, Tongji
Medical College, Huazhong University of Science and Technology,
1277#
Jiefang Ave, Wuhan 430022, China. Tel: 86-27-85726430; Fax:
86-27-85726386. E-mail address:xiemx@hust.edu.cn
The data that support the findings of this study are available from the
corresponding author upon reasonable request.
ABSTRACT
Objective : This study
was conducted to evaluate pre- and intraoperative risk factors for
mortality in patients with Acute type A aortic Dissection (ATAAD).
Methods : 313 patients (264 men and 49 women; mean age,
47.9±9.74 years) were enrolled, who underwent emergency surgery.
Preoperative and operative risk factors for death were presented.
Multiple analysis were performed to identify the influence of factors on
30-day mortality.
Results: Overall, 32
patients (10.2%) died within 30 days. When compared with survived team,
the deceased patients are tachycardia, have more elevated serum
potassium levels, moderate to severe pericardial effusion,
suprasternal branch involvement,
myocardial ischemia, and lower-extremity ischemia. As for factors
related to surgery, the duration of operation, cardiopulmonary bypass
time, concomitant procedure of CABG were greater among patients who
died. On multivariate analysis, independent preoperative risk factors
were longer duration of operation(OR 4.5,p=0.001 ) and
cardiopulmonary bypass time(CPBT)(OR 5.3,p=0.001), moderate to severe
pericardial effusion(OR 3.3,p=0.017), suprasternal branch
involvement(OR 4.9,p=0.002), and lower-extremity ischemia(OR
7.6,p<0.001). Shock or cardiac tamponade were not risk factors.
Conclusions: Lower-extremity ischemia and
suprasternal branch involvement
have the poorest outcome. Moderate to severe pericardial effusion may
influence the outcome. Shorter
duration of operation is associated with better outcomes.
Key Words : Acute type A aortic dissection, Surgery, mortality,
risk factors