Article Abstract

Peri-operative risk factors for in-hospital mortality in acute type A aortic dissection

Authors: Miaoyun Wen, Yongli Han, Jingkun Ye, Gengxin Cai, Wenxin Zeng, Xinqiang Liu, Linqiang Huang, Zhesi Lian, Hongke Zeng

Abstract

Background: Acute type A aortic dissection (TAAD) is cardiovascular emergency and requires surgical interventions. In-hospital mortality rate of surgical-treated TAAD patients remains high. We aim to examine the prognostic implications of peri-operative parameters to identify high-risk patient for in-hospital mortality.
Methods: A total of 264 surgically treated TAAD patients were included in this study. The association between in-hospital mortality and peri-operative parameters were examined.
Results: Thirty patients (11.36%) died during hospitalization. Patients with higher Apache II score had a significantly higher rate of in-hospital mortality when compared with patients scored ≤20 in unadjusted model [Score 21–25: HR =12.9 (1.7–100.8), P=0.0148; Score >25: HR =94.5 (12.6–707.6), P<0.0001]. Patients with Sbp >120 mmHg, Cr >200 mmol/L (both at admission and after surgery), BUN >8.2 mmol/L (both at admission and after surgery), AST >80 µ/L, aortic cross-clamping time >120 min and cardiopulmonary bypass time (CPBT) >230 min were also significantly related to higher rate of in-hospital mortality in univariate analysis. In multivariable analysis, APACHE II score [Score 21–25: HR =9.5 (1.2–74.4), P=0.032; Score >25: HR =51.0 (6.7–387.7), P=0.0001], AST >80 µmol/L [HR =2.3 (1.1–4.8), P=0.0251], aortic cross-clamping time >120 min (HR =2.9 (1.1–7.7), P=0.0315) remained significant in predicting TAAD in-hospital mortality.
Conclusions: APACHE II score could be a useful tool to predict TAAD in-hospital mortality. AST >80 µ/L and aortic cross-clamping time >120 min were also independent predictors.