Preoperative risk factors for hospital mortality in acute type A aortic dissection.
BACKGROUND
Acute type A dissection is associated with postoperative complications and a high mortality rate. This study was performed to determine the perioperative risk factors leading to hospital mortality in patients with acute type A aortic dissection.


METHODS
One hundred twenty-two patients with acute type A aortic dissection treated surgically within 48 hours after onset were enrolled in this study. Thirty-two perioperative risk factors were used in statistical analysis for prediction of mortality. Risk factors for hospital death were investigated with univariate and multiple logistic regression analysis.


RESULTS
The in-hospital mortality rate including operative death was 12.3% (15 of 122 patients) and the actuarial survival rate (including in-hospital death) was 72%+/-6% at 5 years. Univariate analysis revealed 10 risk factors to be statistically significant predictors of hospital death: age, year of operation (1990 to 1995), Marfan syndrome, preoperative ST segment elevation, heart failure from aortic regurgitation, preoperative shock, preoperative coma, long operation time (> 6 hours), long cardiopulmonary bypass time (> 4 hours), and massive blood transfusion (> 20 units) (p < 0.05). Multiple logistic regression analysis confirmed preoperative ST-T segment elevation and massive blood transfusion to be statistically significant independent risk factors for hospital death (p < 0.05).


CONCLUSIONS
Preoperative ST-T elevation and massive blood transfusion during operation were identified as significant independent risk factors for hospital mortality after operation for acute type A aortic dissection. Our findings should contribute to estimation of operative risk in individual patients.
Kawahito
K
K
Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan. kawahito@omiya.jichi.ac.jp
Adachi
H
H
Yamaguchi
A
A
Ino
T
T
D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D004638:Emergency Treatment / Q000379:methods / Q000401:mortality; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011300:Preoperative Care; D018570:Risk Assessment; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality