Mortality in patients with acute aortic dissection type A: analysis of pre- and intraoperative risk factors from the German Registry for Acute Aortic Dissection Type A (GERAADA).
OBJECTIVE
Acute aortic dissection type A (AADA) is an emergency with excessive mortality if surgery is delayed. Knowledge about independent predictors of mortality on surgically treated AADA patients is scarce. Therefore, this study was conducted to identify pre- and intraoperative risk factors for death.


METHODS
Between July 2006 and June 2010, 2137 surgically treated patients with AADA were enrolled in a multicentre, prospective German Registry for Acute Aortic Dissection type A (GERAADA), presenting perioperative status, operative strategies, postoperative outcomes and AADA-related risk factors for death. Multiple logistic regression analysis was performed to identify the influence of different parameters on 30-day mortality.


RESULTS
Overall 30-day mortality (16.9%) increased with age [adjusted odds ratio (OR) = 1.121] and among patients who were comatose (adjusted OR = 3.501) or those who underwent cardiopulmonary resuscitation (adjusted OR = 3.751; all P < 0.0001). The higher the number of organs that were malperfused, the risk for death was (adjusted OR for one organ = 1.651, two organs = 2.440, three organs or more = 3.393, P < 0.0001). Mortality increased with longer operating times (total, cardiopulmonary bypass, cardiac ischaemia and circulatory arrest; all P < 0.02). Arterial cannulation site for extracorporeal circulation, operative techniques and arch interventions had no significant impact on 30-day mortality (all P > 0.1). No significant risk factors, but relevant increases in mortality, were determined in patients suffering from hemiparesis pre- and postoperatively (each P < 0.01), and in patients experiencing paraparesis after surgery (P < 0.02).


CONCLUSIONS
GERAADA could detect significant disease- and surgery-related risk factors for death in AADA, influencing the outcome of surgically treated AADA patients. Comatose and resuscitated patients have the poorest outcome. Cannulation sites and operative techniques did not seem to affect mortality. Short operative times are associated with better outcomes.
HELIOS Clinic for Cardiac Surgery, Karlsruhe, Germany Task Force for Aortic Surgery and Interventional Vascular Surgery of the German Society for Cardiothoracic and Vascular Surgery lars.conzelmann@gmx.de.
Lars Oliver
LO
Conzelmann
Task Force for Aortic Surgery and Interventional Vascular Surgery of the German Society for Cardiothoracic and Vascular Surgery Department of Vascular Surgery and Endovascular Therapy, Evangelical Hospital Hubertus, Berlin, Germany.
Ernst
E
Weigang
HELIOS Clinic for Cardiac Surgery, Karlsruhe, Germany.
Uwe
U
Mehlhorn
Department of Cardiothoracic and Vascular Surgery, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Ahmad
A
Abugameh
Institute for Medical Biometric, Epidemiology und Informatics, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Isabell
I
Hoffmann
Institute for Medical Biometric, Epidemiology und Informatics, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Maria
M
Blettner
Task Force for Aortic Surgery and Interventional Vascular Surgery of the German Society for Cardiothoracic and Vascular Surgery Department of Cardiac Surgery, Heart Center Leipzig, Leipzig, Germany.
Christian D
CD
Etz
Task Force for Aortic Surgery and Interventional Vascular Surgery of the German Society for Cardiothoracic and Vascular Surgery Department of Cardiac and Vascular Surgery, University Hospital Freiburg, Freiburg, Germany.
Martin
M
Czerny
Department of Cardiothoracic and Vascular Surgery, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany.
Christian F
CF
Vahl
D000208:Acute Disease; D000784:Aortic Dissection / Q000401:mortality* / Q000601:surgery; D017544:Aortic Aneurysm, Abdominal / Q000401:mortality* / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000401:mortality* / Q000601:surgery; D002545:Brain Ischemia / Q000209:etiology / Q000401:mortality; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D007431:Intraoperative Complications / Q000401:mortality; D007511:Ischemia / Q000401:mortality; D007866:Leg / Q000098:blood supply; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology / Q000401:mortality; D061646:Operative Time; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D016896:Treatment Outcome
Aorta; Death; Ischaemia; Shock; Surgery