Clinical Analysis Of Risk Factors For Surgery Mortality In Type A Acute Aortic Dissection

Objective: This study was conducted to evaluate pre-and intraoperative risk factors for mortality in patients with Acute type A aortic Dissection(ATAAD).Methods: 313 patients(264 men and 49 women;mean age,47.9±9.74 years)were enrolled,who underwent emergency surgery for ATAAD in Wuhan Union Hospital from February 2012 through February 2017.Preoperative and operative risk factors for death were presented.Multiple analysis were performed to identify the influence of factors on 30-day mortality.Results: Overall,32 patients(10.2%)died within 30 days.When compared with survived team,the deceased patients are tachycardia,have more elevated serum potassium levels,moderate to severe pericardial effusion,involvement of the supra-aortic vessels,myocardial ischemia,and lower-extremity ischemia.As for factors related to surgery,the duration of operation,cardiopulmonary bypass time,concomitant procedure of CABG were greater among patients who died.On multivariate analysis,independent preoperative risk factors were longer duration of operation(OR 4.5,p=0.001)and cardiopulmonary bypass time(OR 5.3,p=0.001),moderate to severe pericardial effusion(OR 3.3,p=0.017),involvement of the supra-aortic vessels(OR 4.9,p=0.002),and lower-extremity ischemia(OR 7.6,p<0.001).Shock or cardiac tamponade were not risk factors.Conclusions: Lower-extremity ischemia and involvement of the supra-aortic vessels have the poorest outcome.Moderate to severe pericardial effusion may influence the outcome.Shorter duration of operation is associated with better outcomes.