ORIGINAL ARTICLES  VASCULAR SECTION 

The Journal of Cardiovascular Surgery 2001 October;42(5):647-50

Copyright © 2009 EDIZIONI MINERVA MEDICA

language: English

Early risk factors in acute type A aortic dissection: is there a predictor of preoperative mortality?

Godon P., Bonnefoy E., Desjeux G., Touboul P.

From the Hôpital Militaire Desgenettes, Lyon, France *Hôpital Cardiovasculaire Louis Pradel, Lyon, France

Background. To ­describe the pre­op­er­a­tive clin­ical, echoc­ar­di­o­graphic and bio­log­ical find­ings in ­patients ­with ­acute ­aortic dis­sec­tion and ­attempt to ­specify ­high ­risk fac­tors of pre­op­er­a­tive mor­tality.
­Methods. A ret­ro­spec­tive, mono­cen­tric ­study of 148 ­patients ­admitted for ­acute ­type A ­aortic dis­sec­tion. All ­patients under­went a clin­ical, echoc­ar­di­o­graphic and bio­log­ical eval­u­a­tion on admis­sion. In 75 ­patients, we meas­ured ­serum car­diac tro­ponin I (­cTnI).
­Results. In hos­pital mor­tality was 25.9% and 15.6% pre­sented ­with pre­op­er­a­tive car­diac cir­cu­la­tory ­arrest (POCCA). ­Patients ­with ­POCCA ­were ­more ­likely ­than ­others to ­have hypo­ten­sion (97±56 vs 144±24 ­mmHg, p<0.01) or ­shock (52% vs 3%, p<0.01) on admis­sion. Per­i­car­dial effu­sion (65% vs 35%, p=0.01) and tam­po­nade (61% vs 8%, p<0.01) ­were ­also sig­nif­i­cantly ­linked to ­POCCA but not the ­aortic ascen­dant diam­eter. Detec­tion of ­cTnI was ­more fre­quent in ­patients ­with ­POCCA (24% vs 7%, p=0.051) and was ­found to be a ­good pre­dictor of in hos­pital mor­tality (47% vs 14%, p<0.01).
Con­clu­sions. For ­patients ­with ­acute ­type A ­aortic dis­sec­tion, hypo­ten­sion or ­shock on admis­sion, per­i­car­dial effu­sion or tam­po­nade, as ­well as ­cTnI detec­tion, ­were the ­main pre­dic­tors for ­POCCA and ­imply imme­diate sur­gery.