Thorac Cardiovasc Surg 2014; 62 - SC25
DOI: 10.1055/s-0034-1367286

The treatment of patients with Type A aortic dissection - predictors for in hospital mortality in 534 patients as two center experience

S. Leontyev 1, J.-F. Légaré 2, M.A. Borger 1, K.J. Buth 2, A.K. Funkat 1, J. Gerhard 1, F.W. Mohr 1
  • 1Herzzentrum Leipzig, Herzchirurgie, Leipzig, Germany
  • 2Queen Elizabeth II Health Sciences Center, Department of Surgery, Division of Cardiac Surgery, Halifax, Canada

Objective: The aim of this study was to evaluate predictors for in hospital mortality after surgical treatment in patients with type A aortic dissection (TypeA) and create an easy to use SCORE card to predict in-hospital mortality.

Methods: We reviewed retrospectively all consecutive patients who underwent surgery for acute TypeA between 1996 and 2011 at the two institution. A logistic regression model was created to identify independent preoperative predictors of in-hospital mortality. The results were then used to create a scorecard predicting operative risk.

Results: A total of 534 consecutive patients were emergently operated for acute TypeA. Mean age was 61 ± 14 years and 36.3% were female. Critical preoperative state was present in 31% of patients and malperfusion of one or more end organs in 36%. Unadjuested in-hospital mortality was 18.7% (n = 100). The most common postoperative complications were: low cardiac output 10.7%, neurological complication 19%, bleeding 22.5%, dialysis 19.7% and sepsis 8.4%. On multivariate analysis preoperative resuscitation (OR 2.6, p < 0.02, 1.14-6.1), visceral malperfusion (OR 3.3, p = 0.002, 1.5-7.1), malperfusion of extremities (OR 2.2, p = 0.002, 1.1-4.2) and coronary artery disease (OR 2.08, p = 0.01, 1.1-3.6) were independent predictors for in-hospital mortality. Age lower than 50 years (OR 0.3, p = 0.01, 0.16-0.8) was protective for early survival. We created an easily usable mortality risk score based on these variables. The patients were stratified into tree risk categories according in-hospital mortality with ranging from  < 5% risk to > 40%. (ROC Curve -0.76; Hosmer and Lemeshow - 0.8)

Conclusion: This represents one of the largest series of patients with Type A aortic dissection in which a risk model was created. Using our approach, we have shown that age, critical preoperative state and malperfusion syndrome were independent risk factors for early mortality.