Contemporary results of surgery in acute type a aortic dissection: The International Registry of Acute Aortic Dissection experience

Santi Trimarchi, Christoph A. Nienaber, Vincenzo Rampoldi, Truls Myrmel, Toru Suzuki, Rajendra H. Mehta, Eduardo Bossone, Jeanna V. Cooper, Dean E. Smith, Lorenzo Menicanti, Alessandro Frigiola, Jae K. Oh, Michael G. Deeb, Eric M. Isselbacher, Kim A. Eagle

Research output: Contribution to journalArticlepeer-review

395 Scopus citations

Abstract

Surgical mortality for acute type A aortic dissection reported in different experiences from single centers or surgeons varies from 7% to 30%. The International Registry of Acute Aortic Dissection, collecting patients from 18 referral centers worldwide, identifies a preoperative risk stratification scheme and a real average surgical mortality for acute type A aortic dissection in the current era. A comprehensive analysis was completed of 290 clinical variables and their relationship to surgical outcomes in 526 of 1032 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 through 2001. Extracted cases, categorized according to risk profile, were defined as unstable (group I) in the presence of cardiac tamponade; shock; congestive heart failure; cerebrovascular accident; stroke; coma; myocardial ischemia, infarction, or both; electrocardiograms with new Q waves or ST elevation; acute renal failure; or mesenteric ischemia-infarction at the time of the operation. Outside of an unstable condition, patients were categorized as stable (group II). The overall in-hospital mortality was 25.1%. Mortality in group I was 31.4% compared with 16.7% in group II (P <. 001). Independent preoperative predictors of operative mortality were history of aortic valve replacement (odds ratio = 3.12), migrating chest pain (odds ratio = 2.77), hypotension as sign of acute type A aortic dissection (odds ratio = 1.95), shock or tamponade (odds ratio = 2.69), preoperative cardiac tamponade (odds ratio = 2.22), and preoperative limb ischemia (odds ratio = 2.10). The International Registry of Acute Aortic Dissection experience confirms that patient selection plays an important role in determining surgical outcomes in patients with acute type A aortic dissection. Knowledge of significant risk factors for operative mortality can contribute to better management and a more defined risk assessment in patients affected by acute type A aortic dissection.

Original languageEnglish (US)
Pages (from-to)112-122
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume129
Issue number1
DOIs
StatePublished - Jan 2005

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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