Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predict...

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Autores principales:	Miriam Freundt, Philipp Kolat, Christine Friedrich, Mohamed Salem, Matthias Gruenewald, Gunnar Elke, Thomas Pühler, Jochen Cremer, Assad Haneya
Formato:	article
Lenguaje:	EN
Publicado:	MDPI AG 2021
Materias:	predictor adverse outcome emergent surgical repair acute type A dissection Medicine R
Acceso en línea:	https://doaj.org/article/333c8b15c45c48e48ef4b15163504cad
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spelling	oai:doaj.org-article:333c8b15c45c48e48ef4b15163504cad2021-11-25T18:02:11ZPreoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up10.3390/jcm102253702077-0383https://doaj.org/article/333c8b15c45c48e48ef4b15163504cad2021-11-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/22/5370https://doaj.org/toc/2077-0383Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.Miriam FreundtPhilipp KolatChristine FriedrichMohamed SalemMatthias GruenewaldGunnar ElkeThomas PühlerJochen CremerAssad HaneyaMDPI AGarticlepredictoradverse outcomeemergent surgical repairacute type A dissectionMedicineRENJournal of Clinical Medicine, Vol 10, Iss 5370, p 5370 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	predictor adverse outcome emergent surgical repair acute type A dissection Medicine R
spellingShingle	predictor adverse outcome emergent surgical repair acute type A dissection Medicine R Miriam Freundt Philipp Kolat Christine Friedrich Mohamed Salem Matthias Gruenewald Gunnar Elke Thomas Pühler Jochen Cremer Assad Haneya Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
description	Background: Acute type A aortic dissection (AAAD) has high mortality. Improvements in surgical technique have lowered mortality but postoperative functional status and decreased quality of life due to debilitating deficits remain of concern. Our study aims to identify preoperative conditions predictive of undesirable outcome to help guide perioperative management. Methods: We performed retrospective analysis of 394 cases of AAAD who underwent repair in our institution between 2001 and 2018. A combined endpoint of parameters was defined as (1) 30-day versus hospital mortality, (2) new neurological deficit, (3) new acute renal insufficiency requiring postoperative renal replacement, and (4) prolonged mechanical ventilation with need for tracheostomy. Results: Total survival/ follow-up time averaged 3.2 years with follow-up completeness of 94%. Endpoint was reached by 52.8%. Those had higher EuroSCORE II (7.5 versus 5.5), higher incidence of coronary artery disease (CAD) (9.2% versus 3.2%), neurological deficit (ND) upon presentation (26.4% versus 11.8%), cardiopulmonary resuscitation (CPR) (14.4% versus 1.6%) and intubation (RF) before surgery (16.9% versus 4.8%). 7-day mortality was 21.6% versus 0%. Hospital mortality 30.8% versus 0%. Conclusions: This 15-year follow up shows, that unfavorable postoperative clinical outcome is related to ND, CAD, CPR and RF on arrival.
format	article
author	Miriam Freundt Philipp Kolat Christine Friedrich Mohamed Salem Matthias Gruenewald Gunnar Elke Thomas Pühler Jochen Cremer Assad Haneya
author_facet	Miriam Freundt Philipp Kolat Christine Friedrich Mohamed Salem Matthias Gruenewald Gunnar Elke Thomas Pühler Jochen Cremer Assad Haneya
author_sort	Miriam Freundt
title	Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_short	Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_full	Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_fullStr	Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_full_unstemmed	Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up
title_sort	preoperative predictors of adverse clinical outcome in emergent repair of acute type a aortic dissection in 15 year follow up
publisher	MDPI AG
publishDate	2021
url	https://doaj.org/article/333c8b15c45c48e48ef4b15163504cad
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Preoperative Predictors of Adverse Clinical Outcome in Emergent Repair of Acute Type A Aortic Dissection in 15 Year Follow Up

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