Contemporary results of surgery in acute type A aortic dissection: The International Registry of Acute Aortic Dissection experience.
BACKGROUND
Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era.


METHODS
A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II).


RESULTS
The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II ( P < .001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10).


CONCLUSIONS
The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.
Trimarchi
Santi
S
Istituto Policlinico S Donato, Milanese, Italy. satrimarchi@yahoo.it
Nienaber
Christoph A
CA
Rampoldi
Vincenzo
V
Myrmel
Truls
T
Suzuki
Toru
T
Mehta
Rajendra H
RH
Bossone
Eduardo
E
Cooper
Jeanna V
JV
Smith
Dean E
DE
Menicanti
Lorenzo
L
Frigiola
Alessandro
A
Oh
Jae K
JK
Deeb
Michael G
MG
Isselbacher
Eric M
EM
Eagle
Kim A
KA
D000208:Acute Disease; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D002315:Cardiopulmonary Bypass; D016001:Confidence Intervals; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007391:International Cooperation; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000401:mortality; D011336:Probability; D011379:Prognosis; D012042:Registries; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*