TY - JOUR
T1 - Simple Risk Models to Predict Surgical Mortality in Acute Type A Aortic Dissection
T2 - The International Registry of Acute Aortic Dissection Score
AU - Rampoldi, Vincenzo
AU - Trimarchi, Santi
AU - Eagle, Kim A.
AU - Nienaber, Christoph A.
AU - Oh, Jae K.
AU - Bossone, Eduardo
AU - Myrmel, Truls
AU - Sangiorgi, Giuseppe M.
AU - De Vincentiis, Carlo
AU - Cooper, Jeanna V.
AU - Fang, Jianming
AU - Smith, Dean
AU - Tsai, Thomas
AU - Raghupathy, Arun
AU - Fattori, Rossella
AU - Sechtem, Udo
AU - Deeb, Michael G.
AU - Sundt, Thoralf M.
AU - Isselbacher, Eric M.
N1 - Funding Information:
We acknowledge the University of Michigan Faculty Group Practice and the Varbedian Fund for Aortic Research for support. The following companies have provided research funding for the current and past calendar year: St. Jude Medical; W.L. Gore and Associates, Inc; Cryolife, Inc; Medtronic, Inc; Atricure, Inc; Thoratec Corp; Carbomedics/Sorin Group; Jarvik Heart, Inc; Baxter; Edwards Lifesciences; Boston Scientific Corp; Avant Immunotherapeutics, Inc; AstraZeneca; and TransTech Pharma, Inc.
PY - 2007/1
Y1 - 2007/1
N2 - Background: Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk. Methods: Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed. Results: The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement. Conclusions: Surgery in unstable patients with acute type A aortic dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
AB - Background: Surgical mortality for acute type A aortic dissection is frequently related to preoperative clinical conditions. We report a predictive score to identify risk of death that may be helpful to assist surgeons who are considering whether to proceed with surgical correction in the case of patients in extreme clinical risk. Methods: Surgical outcome of 682 patients enrolled in the International Registry of Acute Aortic Dissection from 1996 to 2003 was analyzed. Two different models were used. The initial model included only preoperative variables such as demographics, history, symptoms, signs, and diagnostic methods (model 1). The second model also tested intraoperative hemodynamic and surgical variables (model 2). A bedside risk prediction tool to predict operative mortality in individual patients was developed. Results: The overall in-hospital surgical mortality was 23.9%. Independent preoperative predictors of mortality in model 1 were age greater than 70 years, prior cardiac surgery, hypotension (systolic blood pressure less than 100 mm Hg) or shock at presentation, migrating pain, cardiac tamponade, any pulse deficit, and electrocardiogram with findings of myocardial ischemia or infarction. In model 2, other predictors of surgical death were intraoperative hypotension, a right ventricle dysfunction at surgery, and a necessity to perform coronary revascularization. An independent predictor for favorable surgical outcome was right hemiarch replacement. Conclusions: Surgery in unstable patients with acute type A aortic dissection can be highly unsuccessful. The International Registry of Acute Aortic Dissection risk models predict in-hospital mortality using a multivariable risk prediction tool, useful for surgeons and patients as they consider their surgical risk and the pros and cons of embarking on high-risk surgery.
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U2 - 10.1016/j.athoracsur.2006.08.007
DO - 10.1016/j.athoracsur.2006.08.007
M3 - Article
C2 - 17184630
AN - SCOPUS:33845537756
SN - 0003-4975
VL - 83
SP - 55
EP - 61
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -