[Predictors of in-hospital mortality in the surgical management of acute type A aortic dissections: impact of anticoagulant therapies].
OBJECTIVE
The purpose of this investigation was to study the incidence and consequences of anticoagulant therapy in the surgical management of acute aortic dissections.


METHODS
Retrospective study.


METHODS
We reviewed all acute type A aortic dissections that were surgically managed in our institution from 1 January 1990 to 31 December 2000. Survival outcome and characteristics potentially associated with survival were abstracted from patient records. We screened preoperative electrocardiograms (ECG) and anticoagulant therapy.


RESULTS
ST segment elevation incidence was 14% and preoperative anticoagulant therapy occurred in 63 (20%) cases as follow: aspirin 12%, aspirin + heparin 6%, thrombolysis 1%. Overall mortality was 22%. Time between pain and surgery was not statistically different between anticoagulant therapy and standard group. Administration of antithrombotic agents before admission in -hospital increased significantly mortality (Odds ratio (OR) = 2.02; IC [1.1-3.71]; p = 0.023). Other risk factors for death were preoperative circulatory failure (OR = 8.28 [4.23-16.24], p < 0.0001), preoperative cardiac arrest (OR = 21.92 [7.16-67.14], p < 0.0001), preoperative circulatory arrest (OR = 2.79 [1.60-4.88], p = 0.0003), preoperative cerebral perfusion (OR = 2.45 [1.18-5.05], p = 0.016), postoperative circulatory failure (OR = 3.37 [1.85-6.17], p < 0.0001), postoperative cardiac arrest (OR = 9.92 [3.49-28.21], p < 0.0001), postoperative serum creatinine >150 micromol/l (OR = 4.55 [2.43-8.50], p < 0.0001), postoperative dialysis (OR = 5.63 [2.44-13.20], p < 0.0001), more than 7 days of post-operative ventilation (OR = 23.44 [12.0-45.7], p < 0.0001).


CONCLUSIONS
In our experience, 20% of acute type A aortic dissections had received a preoperative anticoagulant therapy. This event is an independent risk factor of in-hospital death and is more frequent in case of ischaemic ECG abnormalities.
Cannesson
M
M
Service d'anesthésie-réanimation, hôpital cardiovasculaire et pneumologique Louis-Pradel, 28, avenue du Doyen-Lépine, 69500 Bron, France. maxime_cannesson@hotmail.com
Burckard
E
E
Lefèvre
M
M
Bastien
O
O
Lehot
J-J
JJ
D000368:Aged; D000704:Analysis of Variance; D000925:Anticoagulants / Q000627:therapeutic use*; D001011:Aorta / Q000601:surgery; D006348:Cardiac Surgical Procedures / Q000401:mortality*; D004562:Electrocardiography / Q000187:drug effects; D005260:Female; D006801:Humans; D007430:Intraoperative Care; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis
D000925:Anticoagulants