Clinical Analysis of risk factors for 30-day mortality in type A acute
aortic dissection: a single-center study from China
Abstract
Objective: This study was conducted to evaluate pre- and intraoperative
risk factors for 30-day mortality in patients with acute type A aortic
dissection (ATAAD). Methods: Three hundred thirteen patients with ATAAD
who underwent emergency surgery (264 men and 49 women; mean age, 48±10
years) were enrolled in our study. Preoperative and operative risk
factors for death were presented. Multivariable analysis was performed
to identify the influence of varying factors on 30-day mortality.
Results: Overall, 32 patients (10.2%) died within 30 days. Compared
with the surviving group, the deceased patients were more likely to have
tachycardia, elevated serum potassium levels, moderate to severe
pericardial effusion, suprasternal branch involvement, myocardial
ischemia, and lower-extremity ischemia. Regarding factors related to
surgery, the duration of surgery and cardiopulmonary bypass and
concomitant procedures of coronary artery bypass graft(CABG) were
greater in patients who died. In multivariate analysis, independent risk
factors were longer duration of surgery (odds ratio [OR]: 4.5,
p=0.001) and cardiopulmonary bypass (OR: 5.3, p=0.001), moderate to
severe pericardial effusion (OR: 3.3, p=0.017), suprasternal branch
involvement (OR: 4.9,p=0.002), and lower-extremity ischemia (OR: 7.6,
p<0.001). Conclusions: Lower-extremity ischemia and suprasternal branch
involvement have the poorest outcomes. Moderate to severe pericardial
effusion could influence the outcome. Shorter duration of surgery is
associated with better outcomes. Key Words: acute type A aortic
dissection, surgery, mortality, risk factors