Clinical presentation is the main predictor of in-hospital death for patients with acute type a aortic dissection admitted for surgical treatment: A 25 years experience.

Background: This retrospective analysis assessed the hypothesis that clinical status on admission more than other variables related to surgicalor post-operative management may influence in-hospital mortality after surgical treatment of acute type A aortic dissection.Methods: Between January 1979 and April 2004, 311 patients, mean age of 59.5±13 years (range, 18 to 88 years), with acute type A aorticdissection were referred for surgery. Logistic regression analysis was applied to demographics, etiological, clinical, and surgical variables, toidentify independent predictors of in hospital death.Results: In hospital mortality rate was 23%. Univariate analysis showed older age (p=0.03, OR1.02/yrs), cardiac tamponade (p=0.001; OR2.43), hypotension (p=0.0001; OR 8), myocardial ischemia (p=0.005; OR 7), acute renal failure (p=0.0001; OR 4.16), limb ischemia(p=0.0002; OR 3.3), neurological deficits pre-op (p=0.0001; OR 8.5), and mesenteric ischemia (p=0.003) as independent predictors of inhospitaldeath. Multivariate analysis identified the following presenting variables as predictors of in-hospital death: hypotension (p=0.003;OR 7.4), myocardial ischemia (p=0.03; OR 5.8), mesenteric ischemia (p=0.009), acute renal failure (p=0.0001; OR 3.9), neurologicaldeficits (p=0.0001; OR 7.7). In-hospital mortality for the group of patients presenting with at least one of the tested pre-operativecomplications (N=158; 51%) was 33% vs 12% (p=00001). No other variables emerged as significant for in-hospital death.Conclusion: In an era of standardized surgical technique, expeditious referral and intervention by lowering preoperative dissection-relatedcomplications and co-morbidities might represent the most efficacious tool to improve results.