Utility of Established Risk Models to Predict Surgical Mortality in Acute Type-A Aortic Dissection

• Published in: Journal of cardiothoracic and vascular anesthesia Vol. 30; no. 1; pp. 39 - 43
• Main Authors: Yu, Pey-Jen, MD, Cassiere, Hugh A., MD, Kohn, Nina, MA, Dellis, Sophia L., MS, Manetta, Frank, MD, Esposito, Rick A., MD, Hartman, Alan R., MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2016
• Subjects: Acute Disease; Aged; Anesthesia & Perioperative Care; Aneurysm, Dissecting - diagnosis; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm - diagnosis; Aortic Aneurysm - mortality; Aortic Aneurysm - surgery; cardiac surgery; Cohort Studies; Critical Care; dissecting aneurysm; Female; Forecasting; Humans; Male; Middle Aged; Models, Theoretical; mortality; Retrospective Studies; Risk Factors; risk models; ROC Curve; Treatment Outcome; type-A; mortality; type-A; cardiac surgery; dissecting aneurysm; risk models
• ISSN: 1053-0770; 1532-8422
• DOI: 10.1053/j.jvca.2015.08.008

Objective The objective of this study was to determine the predictive value of 2 established risk models for surgical mortality in a contemporary cohort of patients undergoing repair of acute type-A aortic dissection. Design Retrospective analysis. Setting Single tertiary care hospital. Participants Seventy-nine consecutive patients undergoing emergent repair of acute type-A aortic dissection between 2008 and 2013. Intervention All patients underwent emergent repair of acute type-A aortic dissection. Measurements and Main Results The receiver operating characteristic curve was compared for each scoring system. Of the 79 patients undergoing emergent repair of acute type-A aortic dissection, 23 (29.1%) were above the age of 70. Seventeen (21.5%) patients presented with hypotension, 25 (31.6%) presented with limb ischemia, and 10 (12.7%) presented with evidence of visceral ischemia. Overall operative mortality was 16.5%. Increasing age was the only preoperative variable associated with increased operative mortality. The areas under the receiver operating characteristic curve for operative mortality was 0.62 and 0.66 for the scoring systems developed by Rampoldi et al and Centofanti et al, respectively. The area under the receiver operating characteristic curve for operative mortality for age was 0.67. The areas under the receiver operating characteristic curve for operative mortality between the 2 scoring systems and for age were not statistically different. Conclusions Existing predictive risk models for acute type-A aortic dissection provide moderate discriminatory power for operative mortality. Age as a single variable may provide equivalent discriminatory power for operative mortality as the established risk models.