BACKGROUND: This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgical or post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection. METHODS: Between January 1979 and April 2004, 311 patients, mean age of 59.5+/-13 years (range, 18 to 88 years), with acute type A aortic dissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, to identify independent predictors of in hospital death. RESULTS: In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR 2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia (p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of in-hospital death. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003; OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurological deficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operative complications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death. CONCLUSION: In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-related complications and co-morbidities might represent the most efficacious tool to improve results.
BACKGROUND: This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgical or post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection. METHODS: Between January 1979 and April 2004, 311 patients, mean age of 59.5+/-13 years (range, 18 to 88 years), with acute type A aortic dissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, to identify independent predictors of in hospital death. RESULTS: In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR 2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia (p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of in-hospital death. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003; OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurological deficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operative complications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death. CONCLUSION: In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-related complications and co-morbidities might represent the most efficacious tool to improve results.
Authors: Bo Yang; Elizabeth L Norton; Carlo Maria Rosati; Xiaoting Wu; Karen M Kim; Minhaj S Khaja; G Michael Deeb; David M Williams; Himanshu J Patel Journal: J Thorac Cardiovasc Surg Date: 2018-12-14 Impact factor: 5.209
Authors: Bo Yang; Carlo Maria Rosati; Elizabeth L Norton; Karen M Kim; Minhaj S Khaja; Narasimham Dasika; Xiaoting Wu; Whitney E Hornsby; Himanshu J Patel; G Michael Deeb; David M Williams Journal: Circulation Date: 2018-11-06 Impact factor: 29.690
Authors: John G T Augoustides; Arnar Geirsson; Wilson Y Szeto; Elizabeth K Walsh; Brittany Cornelius; Alberto Pochettino; Joseph E Bavaria Journal: Nat Clin Pract Cardiovasc Med Date: 2008-12-09