Preoperative Mechanical Ventilation Prior to Surgical Repair for Type A Aortic Dissection: Incidence, Risk, and Outcomes.
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Dell'Aquila Angelo M, Wisniewski Konrad, Georgevici Adrian-Iustin, Szabó Gábor, Onorati Francesco, Demal Till J, Rukosujew Andreas, Peterss Sven, Radner Caroline, Buech Joscha, Fiore Antonio, Perrotti Andrea, Pinto Angel G, Rodriguez Lega Javier, Pol Marek, Kacer Petr, Mazzaro Enzo, Gatti Giuseppe, Vendramin Igor, Piani Daniela, Ferrante Luisa, Rinaldi Mauro, Quintana Eduard, Pruna-Guillen Robert, Di Perna Dario, El-Dean Zein, Sherzad Hiwa, Mariscalco Giovanni, Field Mark, Harky Amer, Kuduvalli Manoj, Pettinari Matteo, Rosato Stefano, Juvonen Tatu, Mäkikallio Timo, Conradi Lenard, Mastroiacovo Giorgio, Biancari Fausto
Аннотация
METHODS: Data from 3735 patients included in the European Registry of Type A Aortic Dissection (ERTAAD) were the subject of this analysis. Bootstrapped Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression was performed for variable selection to identify key predictors of hospital death. In the second step, a multilevel multivariable logistic regression (MMLR) was carried out, given the clustered structure of the data.
RESULTS: A total of 346 (9.3%) out of 3735 patients required preoperative IMV. Compared to the non-IMV patients, patients requiring IMV had a significantly higher rate of organ malperfusion (52% vs. 35%, p < 0.001) and a higher proportion of tears in the aortic root (p = 0.048). The in-hospital mortality rate among IMV patients was 38% vs. 15% in non-IMV patients (p < 0.001), without a difference in post-discharge survival (p = 0.84). At the MMLR, patients who required IMV had 135% higher odds of in-hospital death compared to the remaining patients. IMV yielded the second highest odds in the prediction model for in-hospital mortality (OR 2.13, CI 1.60 to 2.85, p < 0.001). Among IMV patients, the extension of surgery to the aortic arch was significantly associated with increased in-hospital mortality (p < 0.001, OR 2.98). In multivariable analysis, preoperative IMV was independently associated with increased odds of in-hospital mortality.
CONCLUSIONS: The need for invasive mechanical ventilation before surgical repair for type A aortic dissection is not infrequent. In this subpopulation, the in-hospital mortality rate was twofold compared to patients who did not require IMV. The awareness of the preoperative risk profile and outcomes of this subset of patients should urge surgeons to tailor the surgical strategy more appropriately to improve the immediate postoperative results.