Factors influencing early surgical outcomes of patients with acute aortic dissection type A

Abstract

Introduction/Objective Even with the current treatment, mortality from aortic dissection remains high. The study aimed to evaluate the early postoperative outcome of patients with aortic dissection and identify which factors could influence it. Methods The study included all consecutive patients who underwent surgery for acute aortic dissection type A from 2012 to 2017. We registered all parameters that could potentially impact the outcome (general data, medical history, clinical and cardiological diagnostic test findings, preoperative complications, type of cannulation and the operation performed, additional surgical procedures, operation duration, etc.). The patients were surgically treated according to the current protocols. The main outcome measures were complications and mortality during a one-month postoperative period. All data collected pre-, intra-, and postoperatively were compared and statistically analyzed. Results The study included 246 patients, 57.54 ± 12.88 years old on average, and mostly of male sex (74%). Early postoperative mortality occurred in 17% of the patients. Preoperative chronic kidney insufficiency (p = 0.005) and cerebrovascular insult (p = 0.047) and tamponade (p = 0.036) were the major risk factors for postoperative complications and mortality. Long hypothermic cardiac arrest (p = 0.001), cross-clamp (p = 0.017) and cardiopulmonary bypass time (p = 0.036) increased postoperative compli-cations. Postoperative complications started occurring after ≥ 33.5 minutes hypothermic cardiac arrest and ≥ 67.5 minutes cross-clamp time. Postoperative complications occurrence increased (p = 0.034), while performing anterograde cerebral perfusion decreased the frequency of lethal outcome (p = 0.001). Conclusion The majority of patients surgically treated for acute aortic dissection had good postoperative outcome. However, numerous pre-, intra-, and postoperative factors can impact patient survival. © 2021, Serbia Medical Society. All rights reserved.