Simple risk models to predict surgical mortality in acute type A aortic dissection: the International Registry of Acute Aortic Dissection score.
BACKGROUND
Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk.


METHODS
Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed.


RESULTS
The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement.


CONCLUSIONS
Surgery in unstable patients with acute type A aortic dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
Rampoldi
Vincenzo
V
Cardiovascular Center E. Malan, Policlinico S. Donato, S. Donato Milanese, Italy.
Trimarchi
Santi
S
Eagle
Kim A
KA
Nienaber
Christoph A
CA
Oh
Jae K
JK
Bossone
Eduardo
E
Myrmel
Truls
T
Sangiorgi
Giuseppe M
GM
De Vincentiis
Carlo
C
Cooper
Jeanna V
JV
Fang
Jianming
J
Smith
Dean
D
Tsai
Thomas
T
Raghupathy
Arun
A
Fattori
Rossella
R
Sechtem
Udo
U
Deeb
Michael G
MG
Sundt
Thoralf M
TM
Isselbacher
Eric M
EM
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008962:Models, Theoretical; D012042:Registries; D012306:Risk