Abstract 20255: Risk Factors of Mortality in Patients Undergoing Surgical Management of Acute Type a Dissection: A Multivariate Analysis From the International Registry of Acute Aortic Dissection (IRAD)
Background: Acute type A dissection remains a challenging clinical problem. Contemporary surgical outcomes of acute type A aortic dissection along with independent risk factors for mortality are evolving. This study investigates the relationship between postoperative complications and mortality in a large multi-national cohort.
Methods: Of 2741 Type A patients enrolled in IRAD from January 1996-February 2013, 1207 were surgically managed and included in the final model. Univariate correlation between in-hospital mortality and clinical variables used the Chi-squared test or two-sided Fisher test when applicable. Multivariate analysis was performed using iterative binary logistic regression.
Results: 1207 patients with acute type A aortic dissection underwent surgical intervention with an overall in-hospital mortality of 18.1%. Average age was 60.6±13.8, and the cohort was 69.8% male. Independent predictors of operative mortality were age greater than 70 years (OR 1.94), prior cardiac surgery (OR 2.39), presentation with coma/altered consciousness (OR 2.61) and coronary artery compromise (OR 2.06). Post-operative complications associated with hospital death were post-operative coma (OR 11.71), mesenteric ischemia or infarction (OR 9.46), hypotension (OR 8.05), and limb ischemia (OR 4.86).
Conclusions: There are 8 independent predictors of mortality: 4 pre-operative factors and 4 complications. The overall mortality model predicts 84.7% of the outcome. These data may guide decisions about planning treatment and or evaluating outcomes.
Author Disclosures: S.D. Waterford: None. V. Gourineni: None. T. Myrmel: None. K.M. Harris: None. M.P. Ehrlich: None. M.D. Peterson: None. A. Korach: None. D. Gilon: None. A. Bhan: None. B. Reece: None. J.H. Dean: None. D.G. Montgomery: None. C.A. Nienaber: None. E.M. Isselbacher: None. K.A. Eagle: None. A. Khoynezhad: None.
- © 2014 by American Heart Association, Inc.