Results
In this study, 313 surgically treated ATAAD patients were included. Of these patients, 32 (10.2%) died within 30 days.
Compared to the nonsurvivor group, the survivor group had lower heart rates and blood potassium levels. Moderate or severe pericardial effusion, suprasternal branch involvement, myocardial ischemia and lower limb ischemia were less common in patients who survived than in those who did not. However, there were no significant differences in age; blood pressure, blood leukocytes, neutrophils and platelet counts on admission; serum creatinine; ascending aorta diameter; left ventricular ejection fraction; degree of aortic regurgitation; dissection involving the ascending aorta and aortic arch; or lining breach position between the two groups (table 1).
Regarding the intraoperative factors, the durations of procedure and cardiopulmonary bypass time (CPBT) of the patients in the nonsurvivor group were significantly longer than those in the survivor group. Coronary artery bypass graft (CABG) was performed more frequently in the nonsurvivor group than in the survivor group. There were no statistically significant differences between the two groups in terms of aorta occlusion time, cessation time, cerebral perfusion time, ascending aorta replacement, aortic valve replacement, half or whole arch replacement, stenting rhinoplasty or sinus molding (table 2).
ROC curves were used to determine the optimal truncation values for operation time, extracorporeal circulation time, admission heart rate and blood potassium level to identify early mortality in ATAAD patients (table 3, figure 1). ROC analysis revealed that duration of surgery >9.5 h [area under the curve (AUC): 0.73], CPBT >227 min (AUC: 0.72), heart rate >82 beats/min (AUC: 0.65) and plasma potassium >3.8 mmol/l (AUC: 0.71) were more likely to be associated with 30-day mortality in patients with ATAAD.
Multivariable logistic regression analysis revealed that operation time >9.5 h (OR: 4.5; 95% confidence interval [CI]:1.9-10.6; p=0.001), a CPBT >227 min (OR: 5.3; 95% CI:2.1-13.9; p=0.001), moderate to severe pericardial effusion (OR: 3.3; 95% CI: 1.1-9.6; p=0.017), supraventricular branch involvement (OR: 4.9; 95% CI:1.8-13.4; p=0.002), and lower limb ischemia (OR: 7.6; 95% CI: 2.6-22.2; p<0.001) were independent risk factors for early postoperative mortality (table 4).