Perioperative risk factors for mortality in patients with acute type a aortic dissection

Apaydin, Anil Z.; Büket, Suat; Posacıoğlu, Hakan; Îslamoğlu, Fatih; Çalkavur, Tanzer; Yağdı, Tahir; Özbaran, Mustafa; Yüksel, Münevver

doi:10.1016/s0003-4975(02)04096-1

Cited by 67 publications

(42 citation statements)

References 13 publications

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“…3,[7][8][9][10][11][12][13] In our study preoperative malperfusion was the only independent predictor of hospital death. Patients with preoperative malperfusion usually presented with a compromised limb circulation.…”

Section: Discussionsupporting

confidence: 56%

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Aalberts¹,

Boonstra²,

Berg³

et al. 2009

NHJL

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Background. The results of acute type A dissection (AAD) surgery in the Netherlands are largely unknown, as was recently stated in a report by the Health Council of the Netherlands. In order to gain more insight into the Dutch situation we investigated predictors of in-hospital mortality of surgically treated AAD patients and assessed threeyear survival.Methods. 104 consecutive patients undergoing surgery for AAD in a 16-year period (1990-2006) were evaluated. Preoperative and intraoperative variables were analysed to identify predictors of early mortality.Results. Preoperative malperfusion (limb ischaemia or mesenteric ischaemia) was present in 15.4%, shock in 18.3%, and 6.7% were operated under cardiac massage. Marfan syndrome was present in four patients and four patients had a bicuspid aortic valve. In-hospital mortality was 22.1%. Seven patients died intraoperatively; other causes of inhospital mortality were major brain damage in ten patients, multiple organ failure in three patients, low cardiac output in two patients and sudden cardiac death in one patient. Multivariate logistic regression revealed preoperative malperfusion (p=0.004) to be the only independent predictor of in-hospital mortality. Three-year survival was 68.8+/-4.7% (including hospital mortality). Hospital survivors had a three-year survival of 88.3+/-3.9%.Conclusion. In-hospital mortality of our patients (22.1%) is comparable with the results of larger case series published in the literature. Prognosis after successful surgical treatment is relatively good with a three-year survival of 88.3% in our series. (Neth Heart J 2009;17:226-31.).

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Section: Discussionsupporting

confidence: 56%

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Aalberts¹,

Boonstra²,

Berg³

et al. 2009

NHJL

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“…Some ATAAD patients have such advanced presentations, particularly due to malperfusion phenomena, that surgical repair seems futile. The pre-operative presentation of coma or in a collapsed state with shock secondary to either pericardial tamponade or coronary dissection and ischemia are consistent predictive factors for postoperative mortality (39,(53)(54)(55)(56)(57)(58)(59)(60)(61). These and other factors have been incorporated into predictive risk models (56,57) on the basis of International Registry of Aortic Dissection (IRAD) and individual center data (Tables 1, 2, and 3) (46,62), which might aid the decisionmaking of the attending surgeon (46).…”

Section: Ataad Outcomes With and Without Surgerymentioning

confidence: 99%

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Bonser

Ranasinghe

Loubani

et al. 2011

Journal of the American College of Cardiology

215

175

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Acute type A aortic dissection is a lethal condition requiring emergency surgery. It has diverse presentations, and the diagnosis can be missed or delayed. Once diagnosed, decisions with regard to initial management, transfer, appropriateness of surgery, timing of operation, and intervention for malperfusion complications are necessary. The goals of surgery are to save life by prevention of pericardial tamponade or intra-pericardial aortic rupture, to resect the primary entry tear, to correct or prevent any malperfusion and aortic valve regurgitation, and if possible to prevent late dissection-related complications in the proximal and downstream aorta. No randomized trials of treatment or techniques have ever been performed, and novel therapies-particularly with regard to extent of surgery-are being devised and implemented, but their role needs to be defined. Overall, except in highly specialized centers, surgical outcomes might be static, and there is abundant room for improvement. By highlighting difficulties and controversies in diagnosis, patient selection, and surgical therapy, our over-arching goal should be to enfranchise more patients for treatment and improve surgical outcomes.

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“…23,24,[29][30][31][32][33] Despite their prevalence, renal complications are inconsistently reported. Some studies associate renal dysfunction with creatinine levels, 29,34,35 whereas others define it according to urine output 34 or use of dialysis. 36 Many other studies only perfunctorily mention renal dysfunction or failure without providing a clear definition.…”

Section: Renal Systemmentioning

confidence: 99%

Standardizing Clinical End Points in Aortic Arch Surgery

et al. 2014

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1610S ince the introduction of hypothermic circulatory arrest for aortic arch surgery in 1975, 1 there has been considerable progress in addressing this complex surgical pathology. [2][3][4] However, the rapidity with which operative techniques have evolved has outpaced methodical appraisal of their clinical merit, leaving behind a wealth of perfunctory data. In particular, existing emphasis on neurological outcomes has neglected other critical end points, whereas inconsistent definitions and reporting formats limit the applicability of the results of some studies. Robust comparisons between institutional reports are therefore difficult, restricting critical appraisal and summary of existing surgical approaches.The International Aortic Arch Surgery Study Group (IAASSG) has been formed to enable multi-institutional collaboration to better explore the impact of surgical techniques on patient outcomes, using uniform definitions of events and clinical end points. A key endeavor is to standardize reporting formats to facilitate effective comparisons. Such a concerted effort, with the combined expertise of leading academic surgeons, paves the way for a unified language specific for aortic arch surgery that promotes closer cooperation and systematic evaluation and is essential in forming a framework of existing knowledge and guiding progress and research for the future. 5,6The IAASSG has devised a management-orientated classification system for significant clinical end points specific for aortic arch surgery and has undertaken a consensus survey of leading arch surgeons. The following report describes this classification scheme and reports the results of the consensus. Methodology Rationales of the Grading SystemA management-oriented classification system for complications, which grades adverse events by severity on the basis of the management required, is simple, reproducible, and comprehensive.7 It avoids duplication of overlapping results and limits the fluctuating ratings of negative outcomes between institutions by providing standardized definitions. 7,8 Stratifying the severity of relevant complications into grades allows more thorough analysis to be achieved to assist benchmarking of existing procedures, identifying areas in need of improvement, guiding prospective research, and evaluating the effectiveness of interventions. Such an approach has been used widely 7 and has been successfully validated by several subspecialties and procedures. [9][10][11][12][13][14] Variants of this approach have also been implemented for thoracic surgery, resulting in a feasible system that facilitates objective assessments and identifies the burden of individual complications. 15,16 Following the work by Dindo and coworkers, 7 we propose the following system for grading adverse outcomes specific for aortic arch surgery (Table 1). Clinical complications are stratified into 5 major grades, from those that are self-limiting or

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Perioperative risk factors for mortality in patients with acute type a aortic dissection

Cited by 67 publications

References 13 publications

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

In-hospital mortality and three-year survival after repaired acute type A aortic dissection

Evidence, Lack of Evidence, Controversy, and Debate in the Provision and Performance of the Surgery of Acute Type A Aortic Dissection

Standardizing Clinical End Points in Aortic Arch Surgery

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