Role and results of surgery in acute type B aortic dissection: insights from the International Registry of Acute Aortic Dissection (IRAD).
BACKGROUND
The clinical profiles and outcomes of patients treated surgically for acute type B aortic dissection (ABAD) are often reported for those in small series or for those cared for at a single institution over a long time period, during which a continuous evolution in techniques has occurred. Accordingly, we sought to evaluate the clinical features and surgical results of patients enrolled in the International Registry of Acute Aortic Dissection by identifying primary factors that influenced surgical outcome and estimating average surgical mortality for ABAD in the current era.


RESULTS
A comprehensive analysis of 290 clinical variables and their relation to surgical outcomes for 82 patients who required surgery for ABAD (from a population of 1256 patients; mean+/-SD age, 60.6+/-15.0 years; 82.9% male) and who were enrolled in the International Registry of Acute Aortic Dissection was performed. The overall in-hospital mortality was 29.3%. Factors associated with increased surgical mortality based on univariate analysis were preoperative coma or altered consciousness, partial thrombosis of the false lumen, evidence of periaortic hematoma on diagnostic imaging, descending aortic diameter >6 cm, right ventricle dysfunction at surgery, and shorter time from the onset of symptoms to surgery. Factors associated with favorable outcomes included radiating pain, normotension at surgery (systolic blood pressure 100 to 149 mm Hg), and reduced hypothermic circulatory arrest time. The 2 independent predictors of surgical mortality were age >70 years (odds ratio, 4.32; 95% confidence interval, 1.30 to 14.34) and preoperative shock/hypotension (odds ratio, 6.05; 95% confidence interval, 1.12 to 32.49).


CONCLUSIONS
The present study provides insights into current-day clinical profiles and surgical outcomes of ABAD. Knowledge about different preoperative clinical conditions may help surgeons in making treatment decisions among these high-risk patients.
Trimarchi
Santi
S
Cardiovascular Center E. Malan, Policlinico San Donato, via Morandi 30, 20097 San Donato Milanese, Italy. satrimarchi@yahoo.it
Nienaber
Christoph A
CA
Rampoldi
Vincenzo
V
Myrmel
Truls
T
Suzuki
Toru
T
Bossone
Eduardo
E
Tolva
Valerio
V
Deeb
Michael G
MG
Upchurch
Gilbert R
GR
Cooper
Jeanna V
JV
Fang
Jianming
J
Isselbacher
Eric M
EM
Sundt
Thoralf M
TM
Eagle
Kim A
KA
D000208:Acute Disease; D000368:Aged; D000714:Anastomosis, Surgical / Q000706:statistics & numerical data; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery; D000959:Antihypertensive Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery; D001019:Aortic Rupture / Q000209:etiology / Q000601:surgery; D050197:Atherosclerosis / Q000453:epidemiology; D019917:Blood Vessel Prosthesis Implantation / Q000706:statistics & numerical data; D002317:Cardiovascular Agents / Q000627:therapeutic use; D015897:Comorbidity; D004198:Disease Susceptibility; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006331:Heart Diseases / Q000453:epidemiology; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008382:Marfan Syndrome / Q000150:complications / Q000453:epidemiology; D008875:Middle Aged; D010264:Paraplegia / Q000453:epidemiology / Q000209:etiology; D011183:Postoperative Complications / Q000453:epidemiology; D012042:Registries; D020760:Spinal Cord Ischemia / Q000453:epidemiology / Q000209:etiology; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000959:Antihypertensive Agents; D002317:Cardiovascular Agents