Abstract
Introduction Acute aortic dissection Type A (AADA) is still associated with a high mortality rate
and frequent postoperative complications. This study was designed to evaluate the
risk factors for mortality in AADA patients.
Patients and Methods This retrospective analysis included 344 consecutive patients who underwent surgery
for AADA in moderate hypothermic circulatory arrest (20–24°C nasopharyngeal) between
2001 and 2016.
Results The 30-day mortality rate was 18%. Nonsurvivors were significantly older (65.7 ± 12.0
years vs. 62.0 ± 12.5 years; p = 0.034) with significantly higher Euro-score II [15.4% (6.6; 23.0) vs. 4.63% (2.78;
9.88); p < 0.001)]. Intraoperatively, survivors had statistically shorter cardiopulmonary
bypass times [163 (134; 206) vs. 198 min (150; 245); p = 0.001]. However, the hypothermic circulatory arrest time was similar between both
groups. Postoperatively, the incidence of acute kidney injury (AKI) (55.9 vs. 15.2%;
p < 0.001), stroke (27.9 vs. 12.1%; p = 0.002) and sepsis (18.0 vs. 2.1%; p < 0.001) were significantly higher among nonsurvivors. The multi-variable logistic
regression confirmed that older age, previous cardiac surgery, preoperative cardiopulmonary
resuscitation (CPR), blood transfusion and postoperative acute kidney injury (AKI)
were independent risk factors for mortality.
Conclusion Our analysis suggested that the reason for mortality was multifactorial, especially
age, previous cardiac surgery, CPR, transfusion, as well as postoperative AKI were
considered risk factors for mortality.
Keywords
aorta/aortic - aortic valve and root - cardiopulmonary bypass - CPB
