Preoperative predictive factors for mortality in acute type A aortic dissection: an institutional report on 217 consecutives cases.
Surgical treatment of type A acute aortic dissection remains a challenge, especially in elderly patients or in patients with a critical preoperative status. We have retrospectively assessed our series over a 15-year period starting in 1990, including patients operated under cardiac massage for preoperative cardiac arrest occurring in the operating room. There were 217 patients (mean age, 61.5+/-13.5 years; 16 patients >80 years). Preoperative shock was noted in 21.7%, including 14 patients operated under cardiac massage. Operating procedures were: modified Bentall (31%), aortic tube (67.1%), other (1.9%), aortic arch procedure in 26.4%. Overall mortality rate was 19.8% with an exponential increase with age (50% over 80 years). Of 14 patients operated under cardiac massage, three have been discharged: one ventricular fibrillation due to an acute myocardial infarction and two among the 13 with acute aortic ruptures in cardiac arrest (one being a redo, the adhesions limiting the tamponade). Our results confirmed age and preoperative shock prior to surgery as risk factors, and the fact that operating on a patient under cardiac massage for cardiac arrest due to an aortic rupture is probably not a reasonable therapeutic choice.
Department of Cardiac Surgery, CHU, Grenoble, BP 217 University Hospital, Grenoble cedex 9, France. OChavanon@chu-grenoble.fr
Olivier
O
Chavanon
Victor
V
Costache
Vincent
V
Bach
Anis
A
Kétata
Michel
M
Durand
Rachid
R
Hacini
Frédéric
F
Thony
Dominique
D
Blin
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality* / Q000601:surgery*; D016009:Chi-Square Distribution; D017023:Coronary Angiography; D004452:Echocardiography; D005260:Female; D006336:Heart Massage; D006801:Humans; D016015:Logistic Models; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012307:Risk Factors