Risk analysis for hospital mortality in patients with acute type a aortic dissection.
BACKGROUND
Stanford type A acute aortic dissection is a fatal condition requiring emergency surgery. This study was designed to evaluate risk factors for hospital mortality in patients with Stanford type A acute aortic dissection.


METHODS
We studied consecutive 301 patients (163 men and 138 women; mean age, 63.3 years) who underwent emergency surgery for Stanford type A acute aortic dissection from January 1997 through December 2007. The subjects were divided into two groups: patients who were discharged from the hospital, and those who died during hospitalization. Preoperative and operative clinical factors were compared between the groups.


RESULTS
Overall, 41 patients (13.6%) died during hospitalization. On univariate analysis, significant preoperative risk factors for hospital mortality were cardiopulmonary resuscitation, coagulopathy, renal dysfunction, elevated aspartate aminotransferase levels, myocardial ischemia, and lower-extremity ischemia. As for factors related to surgery, the duration of operation, cardiopulmonary bypass time, aortic cross-clamp time, and volume of blood transfusion were greater among patients who died during hospitalization than in those who were discharged from the hospital. On multivariate analysis, independent preoperative risk factors were cardiopulmonary resuscitation, renal dysfunction, and lower-extremity ischemia. Shock or cardiac tamponade were not risk factors.


CONCLUSIONS
Risk factors for hospital mortality in patients with Stanford type A acute aortic dissection were cardiopulmonary resuscitation, renal dysfunction, and lower-extremity ischemia.
Goda
Motohiko
M
Department of Cardiovascular Surgery, Fujisawa City Hospital, Fujisawa-city, Kanagawa, Japan. gogomotto@livedoor.com
Imoto
Kiyotaka
K
Suzuki
Shinichi
S
Uchida
Keiji
K
Yanagi
Hiromasa
H
Yasuda
Shota
S
Masuda
Munetaka
M
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; 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; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome