Determinants of in-hospital mortality after surgery for acute type A aortic dissection.
OBJECTIVE
Acute type A aortic dissection presents a formidable challenge for the cardiac surgeon, although remarkable improvements have been achieved in diagnosis, surgical techniques and perioperative management. The aim of this study was to identify the most important variables associated with in-hospital mortality in patients undergoing surgery for this condition.


METHODS
Between July 1998 and June 2002, 80 patients underwent surgery for acute type A aortic dissection. Univariate and multivariate analyses were performed to identify the variables independently correlated with in-hospital mortality.


RESULTS
The overall in-hospital mortality rate was 20% (16/80 patients). Univariate analysis revealed 24 preoperative and operative variables, including type of surgery, cardiopulmonary bypass (CPB) time, aortic cross-clamp time, diabetes mellitus, and postoperative (postoperative 24 hours) bleeding > or = 1500 mL, as factors associated with in-hospital death. Stepwise logistic regression analysis showed the factors independently associated with in-hospital death were CPB time, diabetes mellitus, and postoperative bleeding > or = 1500 mL (p <0.05).


CONCLUSIONS
Multiple factors affect in-hospital mortality after surgery for acute type A aortic dissection. This study suggests that CPB time, diabetes mellitus and postoperative bleeding > or = 1500 mL are the main determinants of in-hospital death.
Cardiovascular Division of Surgery, Taichung Veterans General Hospital, Taichung City, Taiwan.
Hung-Wen
HW
Tsai
Shih-Rong
SR
Hsieh
Hao-Ji
HJ
Wei
Chung-Chi
CC
Wang
Yen
Y
Chang
Hui-Ching
HC
Ho
D000293:Adolescent; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality* / Q000601:surgery*; D002423:Cause of Death; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D012307:Risk Factors; D018709:Statistics, Nonparametric