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