In-hospital major adverse outcomes of acute Type A aortic dissection

OBJECTIVES Acute Type A aortic dissection exhibits poor in-hospital outcomes after emergency surgery. Evaluation of risk predictors for in-hospital major adverse outcomes (MAO) is key to reducing the mortality rate and improving the quality of care. METHODS We enrolled 70 patients who presented with postoperative MAO and 195 patients who recovered well. Through univariate and multivariate analyses, clinical characteristics were compared between the patients in the 2 groups. RESULTS In-hospital mortality was 6.4% in this series. The patients in the MAO group were older and had a higher frequency of coronary artery involvement by dissection (60.0% vs 21.0%) (P<0.05). Preoperatively, when compared to the group of patients without MAO, the patients in the MAO group were more likely to have a neurological deficit (18.6% vs 9.7%) and, to a certain extent, lower limb symptoms encompassing visceral and renal malperfusion (20.0% vs 8.2%) (P<0.05). Compared to patients with MAO, patients without MAO experienced longer duration from initial onset of symptoms to surgery and had an ascending aorta with a larger diameter. In patients with MAO, the average durations of cardiopulmonary bypass (CPB), cardiac arrest and hypothermic circulatory arrest were much longer than those in patients with no MAO (all P<0.001). Multivariate analysis showed that in-hospital adverse outcomes were associated with older age [odds ratio (OR) = 1.047 (1.008-1.087), P<0.05], presentation of lower limb symptoms prior to surgery [OR=2.905 (1.109-7.608), P<0.05] and long CPB duration [OR=1.011 (1.005-1.018), P<0.01]. When patients with acute Type A aortic dissection experienced a duration from symptom onset to surgery [OR=0.993 (0.987-0.999), P<0.05] or had an ascending aorta with a large diameter [OR=0.942 (0.892-0.995), P<0.05], the number of postoperative adverse events decreased significantly. CONCLUSIONS At a centre that has a large caseload, where practitioners can become proficient through experience as well as training, good outcomes can be dependably produced in patients with acute Type A aortic dissection and without malperfusion syndromes. For patients presenting with these risk features, MAO need to be anticipated, and the incidence of a composite end point of major adverse events remains unsatisfactory.