Impact of GERAADA score in patients with acute type A aortic dissection

Abstract

Background Despite continuous developments and advances in the perioperative management of patients suffering from acute aortic dissection type A (AADA), the associated postoperative morbidity and mortality remain high and strongly depend on the preoperative clinical status. The associated postoperative mortality is still hard to predict prior to the surgical procedure. The so-called German Registry of Acute Aortic Dissection Type A (GERAADA) score uses very basic and easily retrievable parameters and was specifically designed for predicting the 30-day mortality rate in patients undergoing surgery for AADA. This study evaluated impact of the GERAADA score in the authors’ institutional results. Methods Among 101 acute type A aortic dissection patients treated at our hospital during August 2015–March 2021, the GERAADA was calculated individually and retrospectively. Predicted and actual mortalities were assessed, and independent predicted factors were searched. The primary endpoint was defined as comparison of GERAADA scores and early mortality, and the secondary endpoints were defined as comparison of GERAADA scores and other postoperative results, and comparison of preoperative factors and postoperative results regardless to GERAADA scores. Results While the overall 30-day mortality for the entire study cohort calculated by the GERAADA score was 14.3 (8.1–77.6)%, the actual mortality rate was 6%. However, the GERAADA score was significantly high in some postoperative complications and showed significant correlation with some peri- and post-operative factors. In addition, factors not belonging to GERAADA score such as time from onset to arrival at the hospital, time from onset to arrival at the operation room, spouse presence, and hemodialysis were significantly associated with 30-day mortality. Conclusions Although the actual mortality was lower than predicted, GERAADA score may impact on the postoperative course. In addition, it would be desirable to add parameters such as the time from onset to arrival, family background, and hemodialysis for further accuracy.

Validation of the German Registry for Acute Aortic Dissection Type A Score in predicting 30-day mortality after type A aortic dissection surgery

“…Sugiyama et al . [ 18 ] have also compared the GERAADA predicted mortality and found that the score tends to overestimate the actual mortality (14.3% predicted vs 6% actual): in this study, the authors were unable to calculate the accurate AUC due to a very low mortality rate. On the other hand, Luehr et al .…”

Histopathological Gap in Aortic Diseases: A Prospective Analysis

“…In patients with aortic disease, the mortality rate at various stages (pre-, peri-, and postoperative) remains high, and the time from diagnosis to treatment does not seem consistently brief [4,14,15]. Although postoperative complications could raise overall mortality, these factors are secondary to the primary cause, which is the rapid development of aortic disease.…”

Impact of Direct or Indirect Transfer on Acute Type A Aortic Dissection in The Tokai Region of Japan

“…Cerebrovascular disease was defined as permanent neurological dysfunction. The German Registry for Acute Aortic Dissection Type A (GERAADA) score is a simple and effective tool for predicting the 30-day mortality rate of patients undergoing surgery for ATAAD [10][11][12][13].…”

“…Preoperative clinical status, rather than operative complexity, is the primary factor affecting postoperative mortality and outcomes in ATAAD [1,[10][11][12][13]. Patients presenting with emergent conditions such as cardiac tamponade, hypotension, or shock tend to undergo more rapid treatment [3,4].…”