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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

Indexed/Abstracted in: BIOSIS Previews, Current Contents/Clinical Medicine, EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,632

Periodicità: Bimestrale

ISSN 0021-9509

Online ISSN 1827-191X


The Journal of Cardiovascular Surgery 2001 Agosto;42(4):517-24



A preoperative index of mortality for patients undergoing surgery of type A aortic dissection

Spirito R., Pompilio G., Alamanni F., Agrifoglio M., Dainese L., Parolari A., Reali M., Grillo F., Fusari M., Biglioli P.

From the Department of Cardiovascular Surgery University of Milan, Cardiological Center “I Monzino” Foundation, ­IRCCS, Milan, Italy

Background. The aim of ­this ­study was to iden­ti­fy and strat­i­fy the ­most impor­tant pre­op­er­a­tive fac­tors for in-hos­pi­tal ­death ­after sur­gery for ­type A aor­tic dis­sec­tion.
Methods. From January 1985 to June 1998, 108 ­patients under­went sur­gery for ­type A aor­tic dis­sec­tion. 89.9% of the patients had an ­acute ­type A dis­sec­tion (AD), where­as 11.1% had a chron­ic dis­sec­tion (CD). Cardiac tam­po­nade and ­shock ­occurred in 22% and 14.8% of the patients, respec­tive­ly. The loca­tion of the pri­mary inti­mal ­tear was in the ascend­ing aor­ta in 71.2% of the cas­es, in the ­arch in 16.6% and in the descend­ing aor­ta in 7.4%. Univariate and mul­ti­var­i­ate anal­y­ses ­were con­duct­ed to iden­ti­fy non-embol­ic var­i­ables inde­pen­dent­ly cor­re­lat­ed to in-hos­pi­tal ­death. A pre­dic­tive mod­el of in-hos­pi­tal mor­tal­ity was ­then con­struct­ed by ­means of a math­e­mat­i­cal meth­od ­with the var­i­ables select­ed ­from logis­tic regres­sion anal­y­sis.
Results. The over­all in-hos­pi­tal mor­tal­ity ­rate was 20.3% (22/108 ­patients), ­being 9% for CD and 21.6% for AD. Emergent pro­ce­dures had an in-hos­pi­tal mor­tal­ity ­rate of 47.6%, where­as non-emer­gent oper­a­tions had an in-hos­pi­tal mor­tal­ity ­rate of 13.7% (p<0.01). Univariate anal­y­sis ­revealed ­among 39 pre­op­er­a­tive and oper­a­tive var­i­ables, age (­years), age >70 ­years, ­remote myo­car­dial infarc­tion, cereb­ro­vas­cu­lar dys­func­tion, dia­betes, pre­op­er­a­tive ­renal fail­ure, ­shock, car­di­o­pul­mo­nary ­bypass ­time (min­utes), emer­gen­cy oper­a­tion as fac­tors asso­ciat­ed to in-hos­pi­tal ­death (p<0.05). Stepwise logis­tic regres­sion anal­y­sis select­ed as inde­pen­dent pre­dict­ing var­i­ables (p<0.05), ­remote myo­car­dial infarc­tion (p=0.006), pre­op­er­a­tive ­renal fail­ure (p=0.032), ­shock (p=0.001), age >70 ­years (p=0.007). Finally, a prob­abil­ity ­table of ­death ­risk was ­obtained ­with the logis­tic regres­sion coef­fi­cients. The low­er ­death prob­abil­ity (10.6%) was cal­cu­lat­ed in ­absence of ­risk var­i­ables; the high­er one in pres­ence of all of ­them (79.7%). Between ­these ­extremes, a ­total of 64 com­bi­na­tions of ­death ­risk ­were ­obtained.
Conclusions. Increasing age, ­shock, cor­o­nary ­artery dis­ease and ­renal fail­ure are var­i­ous­ly asso­ciat­ed to a ­high ­risk of in-hos­pi­tal ­death ­after sur­gi­cal cor­rec­tion of ­type A aor­tic dis­sec­tion. This pre­dic­tive mod­el of ­death prob­abil­ity ­allows to col­lo­cate pre­op­er­a­tive­ly ­patients ­with ­type A aor­tic dis­sec­tion at dif­fer­ent lev­els of ­risk for in-hos­pi­tal ­death.

lingua: Inglese


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