title: Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience.
abstract: BACKGROUND
  This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgical or post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection.
  
  
  METHODS
  Between January 1979 and April 2004, 311 patients, mean age of 59.5+/-13 years (range, 18 to 88 years), with acute type A aortic dissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, to identify independent predictors of in hospital death.
  
  
  RESULTS
  In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR 2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia (p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of in-hospital death. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003; OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurological deficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operative complications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death.
  
  
  CONCLUSIONS
  In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-related complications and co-morbidities might represent the most efficacious tool to improve results.
authors.affiliation: Division of Cardiac Surgery, University of Verona, OCM Borgo Trento, Piazzale Stefani 1, 37126 Verona, Italy. fsant@yahoo.com
authors.forename: Francesco
authors.initials: F
authors.lastname: Santini
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Montalbano
authors.forename: Gianluca
authors.initials: G
authors.lastname: Casali
authors.forename: Antonio
authors.initials: A
authors.lastname: Messina
authors.forename: Mauro
authors.initials: M
authors.lastname: Iafrancesco
authors.forename: Giovanni Battista
authors.initials: GB
authors.lastname: Luciani
authors.forename: Andrea
authors.initials: A
authors.lastname: Rossi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Mazzucco
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation / Q000379:methods / Q000401:mortality; D002423:Cause of Death; D016009:Chi-Square Distribution; D015331:Cohort Studies; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011183:Postoperative Complications / Q000175:diagnosis / Q000401:mortality; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D011859:Radiography; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D017678:Sex Distribution; D016019:Survival Analysis; D014656:Vascular Surgical Procedures / Q000379:methods / Q000401:mortality