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Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience.

Abstract：

BACKGROUND:This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgical or post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection. METHODS:Between January 1979 and April 2004, 311 patients, mean age of 59.5+/-13 years (range, 18 to 88 years), with acute type A aortic dissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, to identify independent predictors of in hospital death. RESULTS:In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR 2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia (p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of in-hospital death. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003; OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurological deficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operative complications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death. CONCLUSION:In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-related complications and co-morbidities might represent the most efficacious tool to improve results.

journal_name

Int J Cardiol

journal_title

International journal of cardiology

authors

Santini F,Montalbano G,Casali G,Messina A,Iafrancesco M,Luciani GB,Rossi A,Mazzucco A

doi

10.1016/j.ijcard.2006.03.013

subject

Has Abstract

pub_date

2007-02-14 00:00:00

pages

305-11

issue

eissn

0167-5273

issn

1874-1754

pii

S0167-5273(06)00401-3

journal_volume

115

pub_type

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Clinical presentation is the main predictor of in-hospital death for patients with acute type A aortic dissection admitted for surgical treatment: a 25 years experience.