title: Impact of organ failure and major complications on outcome in acute Type A aortic dissection.
abstract: OBJECTIVE
  Organ failure and major complications after operations for acute Type A aortic dissection impair outcomes. The objective was to analyze the prevalence of organ failure and major complications, their interrelationship and predictors, and their impact on early and late survival.
  
  
  METHODS
  All operative survivors 1990-2009 (n = 335) were retrospectively reviewed. Predictors of organ failure and major complications (bleeding, infection, renal or respiratory failure, neurological dysfunction, and multisystem organ failure) and their influence on in-hospital and long-term mortality were analyzed with multivariable statistical methods.
  
  
  RESULTS
  Major complication(s) occurred in 153 patients (46%), most frequently bleeding and permanent neurological dysfunction (19% each). Increasing organ system failure index increased in-hospital mortality markedly: zero (2.9%), one (14%), two (33%), three or more (43%), p = 0.002. Reoperation for bleeding (odds ratio [95% confidence interval]) 2.6 [1.1-6.3], multisystem organ failure 4.3 [1.4-13], and permanent neurological dysfunction 14 [6.2-32] were related to in-hospital mortality. The latter two and respiratory failure also entailed increased long-term mortality.
  
  
  CONCLUSIONS
  Organ failure and major complications were common and impacted negatively on both in-hospital and long-term survival. Strategies to avoid or treat organ failure and major complications should improve early and late survival after surgery for acute Type A aortic dissection.
authors.affiliation: Department of Molecular Medicine and Surgery, Cardiovascular Surgery Unit, The Karolinska Institute and Karolinska University Hospital , Stockholm , Sweden.
authors.forename: Christian
authors.initials: C
authors.lastname: Olsson
authors.forename: Anders
authors.initials: A
authors.lastname: Franco-Cereceda
mesh_terms: D000208:Acute Disease; D000368:Aged; D000784:Aortic Dissection / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D001014:Aortic Aneurysm / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality; D009422:Nervous System Diseases / Q000453:epidemiology; D019106:Postoperative Hemorrhage / Q000453:epidemiology / Q000601:surgery; D015995:Prevalence; D016016:Proportional Hazards Models; D012086:Reoperation; D012131:Respiratory Insufficiency / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D013548:Sweden / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000401:mortality