Edvard Skripochnik1, Patricia Friedman1, Robert E Michler1, Siyamek Neragi-Miandoab2. 1. Department of Cardiovascular and Thorscic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, USA. 2. Staten Island University Hospital, Department of Cardiothoracic Surgery, New York, USA siyamekneragi@yahoo.com.
Abstract
BACKGROUND: Type A aortic dissection is a serious and fatal condition. METHODS: We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5 ± 13.8 years, who were treated between 2006 and 2011. Most patients were male (70, 65%). RESULTS: Circulatory arrest with a mean duration of 22 ± 16 min was performed in 42 (38.9%) patients. Perioperative mortality was 15.7% (n = 17). Univariate analysis showed that cardiopulmonary bypass time (p = 0.0006), age >60 years (p = 0.028), cardiogenic shock at presentation (p = 0.02), New York Heart Association class II-IV (p = 0.038), hemopericardium (p = 0.0035), and preoperative cerebrovascular accident (p = 0.02) were predictors of mortality. Multivariate analysis indicated that age >60 years (odds ratio 7.7, 95% confidence interval: 1.52-38.96, p = 0.0136), preoperative cerebrovascular accident (odds ratio 25.2, 95% confidence interval: 2.45-258.9, p = 0.0066), hemopericardium (odds ratio 41.6, 95% confidence interval: 5.38-320.7, p = 0.0003), and cardiopulmonary bypass time (odds ratio 1.85, 95% confidence interval: 1.32-2.57, p = 0.0003) were independent predictors of perioperative mortality. The 1- and 4-year survival was 80% ± 3.8% and 69% ± 5.7%, respectively. Age >60 years (hazard ratio 3.3, 95% confidence interval: 1.4-7.9, p = 0.0064) was the only independent predictor of long-term mortality. CONCLUSION: Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.
BACKGROUND: Type A aortic dissection is a serious and fatal condition. METHODS: We retrospectively evaluated the outcome following repair of ascending aortic dissection in a contemporary cohort of 108 patients with a mean age of 59.5 ± 13.8 years, who were treated between 2006 and 2011. Most patients were male (70, 65%). RESULTS: Circulatory arrest with a mean duration of 22 ± 16 min was performed in 42 (38.9%) patients. Perioperative mortality was 15.7% (n = 17). Univariate analysis showed that cardiopulmonary bypass time (p = 0.0006), age >60 years (p = 0.028), cardiogenic shock at presentation (p = 0.02), New York Heart Association class II-IV (p = 0.038), hemopericardium (p = 0.0035), and preoperative cerebrovascular accident (p = 0.02) were predictors of mortality. Multivariate analysis indicated that age >60 years (odds ratio 7.7, 95% confidence interval: 1.52-38.96, p = 0.0136), preoperative cerebrovascular accident (odds ratio 25.2, 95% confidence interval: 2.45-258.9, p = 0.0066), hemopericardium (odds ratio 41.6, 95% confidence interval: 5.38-320.7, p = 0.0003), and cardiopulmonary bypass time (odds ratio 1.85, 95% confidence interval: 1.32-2.57, p = 0.0003) were independent predictors of perioperative mortality. The 1- and 4-year survival was 80% ± 3.8% and 69% ± 5.7%, respectively. Age >60 years (hazard ratio 3.3, 95% confidence interval: 1.4-7.9, p = 0.0064) was the only independent predictor of long-term mortality. CONCLUSION: Our results identify the major risk factors for perioperative and long-term mortality. Age is an independent risk factor for mortality.
Authors: Hammad M A Aliahmed; Rimantas Karalius; Arūnas Valaika; Arimantas Grebelis; Palmyra Semėnienė; Rasa Čypienė Journal: Medicina (Kaunas) Date: 2018-04-28 Impact factor: 2.430