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

• Published in: Journal of cardiovascular surgery Vol. 42; no. 5; pp. 647 - 650
• Main Authors: Godon, P, Bonnefoy, E, Desjeux, G, Touboul, P
• Format: Journal Article
• Language: English
• Published: Italy Edizioni Minerva Medica 01.10.2001
• Subjects: Acute Disease; Adult; Aged; Aged, 80 and over; Aneurysm, Dissecting - mortality; Aneurysm, Dissecting - surgery; Aortic Aneurysm, Thoracic - mortality; Aortic Aneurysm, Thoracic - surgery; Chi-Square Distribution; Echocardiography; Female; Hospital Mortality; Humans; Male; Middle Aged; Predictive Value of Tests; Retrospective Studies; Risk Factors; Survival Rate
• ISSN: 0021-9509; 1827-191X

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. 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). 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). 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.