Clinical features and risk factors of postoperative in-hospital mortality following surgical repair of Stanford type A acute aortic dissection

Chen Ke,Min Xi,Guirong Lu,Wei Shi,Qihong Huang,Hao Wu

doi:10.1186/s12872-021-02107-1

Abstract

BackgroundTo investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate.MethodsThe demographic and clinical data were retrospectively collected and analyzed from 118 AAD patients admitted to the Affiliated Hospital of Hangzhou Normal University from June 2016 to April 2019. All patients underwent surgical treatment and were grouped into death and survival groups. The risk factors affecting postoperative in-hospital death were analyzed using multivariate logistic regression analysis.ResultsThe male to female ratio in the patients was 3.8:1 and the mean age was 50.11 ± 9.91 years. The patient’s main comorbidities were hypertension (70.33%) and coronary heart disease (10.17%). The main symptoms included chest pain and back pain (72.89%). The highest incidence of complications was pericardial effusion (48.31%), followed by pleural effusion (22.88%). The mean systolic blood pressure, white blood cell count and D-dimer in the patients were over the ranges of normal people. The incidences of cardiac and renal insufficiency were 18.64% and 16.95% respectively, and the postoperative in-hospital mortality rate was 12.71%. Univariable analysis showed that age, renal insufficiency, cardiac insufficiency, D-dimer level, cardiopulmonary bypass time, operation time, blood transfusion volume and postoperative hemostasis were significant factors leading to the death (P < 0.05). Multivariate logistic regression analysis showed that age > 65, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis were independent risk factors for the death (P < 0.05).ConclusionsAAD patients frequently have underlying diseases with pain as the main symptom. Age > 65 years, renal insufficiency, cardiopulmonary bypass time ≥ 250 min and postoperative hemostasis are significantly risk factors for postoperative mortality.

Highlights

To investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate
Because the tear may occur in different sites and multiple organs are involved in this type of patients, Stanford type A AAD is more complicated than Stanford type B AAD
Earlier studies showed that age, preoperative stroke, preoperative shock and cardiopulmonary bypass time are risk factors of death in AAD patients, but the operation methods, aortic intubation and perfusion are not related to postoperative death [21]

Summary

Introduction

To investigate the clinical features of patients with Stanford type A acute aortic dissection (AAD) and analyze the risk factors affecting postoperative in-hospital mortality rate. Nontraumatic Stanford type A acute aortic dissection (NTAD) is a life-threatening condition. The mortalities at 48 h and 2 weeks from onset are 50 and 80%, respectively [7] This dissection in Stanford type A AAD often involves the ascending aorta proximal to the brachiocephalic trunks, the aortic arch and the descending aorta. Because the tear may occur in different sites and multiple organs are involved in this type of patients, Stanford type A AAD is more complicated than Stanford type B AAD. It often occurs acutely with rapid progress and poor prognosis, seriously threatening the life of patients [8, 9]

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