Lars Oliver Conzelmann1, Ernst Weigang2, Uwe Mehlhorn3, Ahmad Abugameh4, Isabell Hoffmann5, Maria Blettner5, Christian D Etz6, Martin Czerny7, Christian F Vahl4. 1. 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. 2. 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. 3. HELIOS Clinic for Cardiac Surgery, Karlsruhe, Germany. 4. Department of Cardiothoracic and Vascular Surgery, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany. 5. Institute for Medical Biometric, Epidemiology und Informatics, Medical Centre of the Johannes Gutenberg-University Mainz, Mainz, Germany. 6. 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. 7. 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.
Abstract
OBJECTIVES: 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.
OBJECTIVES: 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 AADApatients 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 AADApatients. 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.
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: R Scott McClure; Maral Ouzounian; Munir Boodhwani; Ismail El-Hamamsy; Michael W A Chu; Zlatko Pozeg; Francois Dagenais; Khokan C Sikdar; Jehangir J Appoo Journal: Aorta (Stamford) Date: 2017-04-01
Authors: Paolo Berretta; Himanshu J Patel; Thomas G Gleason; Thoralf M Sundt; Truls Myrmel; Nimesh Desai; Amit Korach; Antonello Panza; Joe Bavaria; Ali Khoynezhad; Elise Woznicki; Dan Montgomery; Eric M Isselbacher; Roberto Di Bartolomeo; Rossella Fattori; Christoph A Nienaber; Kim A Eagle; Santi Trimarchi; Marco Di Eusanio Journal: Ann Cardiothorac Surg Date: 2016-07
Authors: Yskert von Kodolitsch; Oliver Wilson; Helke Schüler; Axel Larena-Avellaneda; Tilo Kölbel; Sabine Wipper; Fiona Rohlffs; Christian Behrendt; E Sebastian Debus; Jens Brickwedel; Evaldas Girdauskas; Christian Detter; Alexander M Bernhardt; Jürgen Berger; Stefan Blankenberg; Hermann Reichenspurner; Tamer Ghazy; Klaus Matschke; Ralf-Thorsten Hoffmann; Norbert Weiss; Adrian Mahlmann Journal: Cardiovasc Diagn Ther Date: 2017-12