A1 Refereed original research article in a scientific journal
Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection
Authors: Biancari Fausto, Dell'Aquila Angelo M., Onorati Francesco, Rossetti Cecilia, Demal Till, Rukosujew Andreas, Peterss Sven, Buech Joscha, Fiore Antonio, Folliguet Thierry, Perrotti Andrea, Hervé Amélie, Nappi Francesco, Conradi Lenard, Pinto Angel G., Lega Javier Rodriguez, Pol Marek, Kacer Petr, Wisniewski Konrad, Mazzaro Enzo, Gatti Giuseppe, Vendramin Igor, Piani Daniela, Ferrante Luisa, Rinaldi Mauro, Quintana Eduard, Pruna-Guillen Robert, Gerelli Sebastien, Di Perna Dario, Acharya Metesh, Mariscalco Giovanni, Field Mark, Kuduvalli Manoj, Pettinari Matteo, Rosato Stefano, Mustonen Caius, Kiviniemi Tuomas, Roberts Charles S., Mäkikallio Timo, Juvonen Tatu
Publisher: Elsevier
Publication year: 2024
Journal: American Journal of Cardiology
Journal name in source: The American journal of cardiology
Journal acronym: Am J Cardiol
Volume: 217
First page : 59
Last page: 67
ISSN: 0002-9149
eISSN: 1879-1913
DOI: https://doi.org/10.1016/j.amjcard.2024.01.035
Web address : https://doi.org/10.1016/j.amjcard.2024.01.035
Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
