Operative mortality predictors in patients with acute type A aortic dissection.

OBJECTIVE

To develop a model capable of predicting risk factors for operative in-hospital mortality in patients diagnosed with acute type A aortic dissection, that includes inflammatory biomarkers and imaging variables of the ascending aorta in the acute phase.

DESIGN

Unicentric retrospective analysis.

SETTING

Cardiac surgery unit.

PATIENTS: Adult patients undergoing cardiac surgery after acute type A aortic dissection, during a 11-year period.

MAIN VARIABLES OF INTEREST: Pre- and intraoperative risk factors for mortality, inflammatory markers and ascending aortic diameter, at the time of diagnosis.

RESULTS

120 patients were analysed. The presence of preoperative visceral ischemia (OR) 7.48, 95% confidence interval (CI) (1.98-28.18); (p: 0.003); redo cardiac surgery (OR: 10.07, 95% CI (1.62-62.27); (p: 0.013); preoperative dual antiplatelet therapy (OR: 7.21, 95% CI (1.45-35.69); (p: 0.015) and the neutrophil/lymphocyte ratio (OR: 1.11; 95% CI (1.03-1.20); (p: 0.006) were independent predictors for operative mortality in the analysed sample. These risk factors were included in a model to predict operative mortality, which also included ascending aortic diameter, with an area under the ROC curve of 0,793 ± 0,052; IC 95% (0,691-0,895); (P < 0,0001).

CONCLUSIONS

The inclusion of variables that quantify inflammatory activity, as well as imaging variables at the time of diagnosis of acute type A aortic dissection, may contribute to a more accurate estimate of surgical risk.