Is Surgery Always Mandatory for Type A Aortic Dissection?
From: Cardiac Surgery Division, University of Turin, Turin, Italy. paolocentofanti@tiscali.it
The Annals of thoracic surgery
- Publish Date: Nov 2006
- ISSN: 1552-6259
- Volume: 82
- Issue: 5
- Pages: 1658-63; discussion 1664
- Medium: Internet
- Language: English
- Citation (JAMA): Centofanti Paolo, Flocco Roberto, Ceresa Fabrizio, et al. Is Surgery Always Mandatory for Type A Aortic Dissection?. Ann. Thorac. Surg. Nov 2006;82:1658-63; discussion 1664
Abstract
BACKGROUND: The International Registry of Aortic Dissections showed that 42% of the unoperated patients with type A acute aortic dissection were discharged from the hospital after intensive medical treatment. We analyzed our experience to identify a preoperative score for in-hospital mortality to propose an alternative strategy for type A acute aortic dissection. METHODS: From 1980 to 2004, 616 consecutive patients with type A acute aortic dissection underwent surgery in our center. The preoperative univariate risk factors with a probability value less than 0.05 were entered into multivariate analysis. A risk equation was developed: predicted mortality = exp(beta 0 + sigma beta i X i)/[1 + exp(beta 0 + sigma beta i X i)]. RESULTS: Early mortality was 25.1% (154 of 616 patients). Five risk factors were identified: age, coma, acute renal failure, shock, and redo operation. The beta i values are age 0.023, shock 0.771, reoperation 0.595, coma 1.162, acute renal failure 0.778; the constant (beta 0) is -2.986. CONCLUSIONS: Our large, single-center experience allowed us to develop a mathematical model to predict 30-day mortality for type A acute aortic dissection. When the expected mortality is 58% or less, surgery is always indicated. When the predicted mortality is greater than 58%, the possibility of survival is similar, according to International Registry of Aortic Dissections data, for surgery and medical treatment. In such cases surgery can no longer be considered mandatory, and a careful evaluation of the individual patient is recommended to choose the more suitable strategy.
Mesh Headings (Keywords): Aged, Aneurysm, Dissecting, Aortic Aneurysm, Cardiovascular Surgical Procedures, Female, Hospital Mortality, Humans, Male, Middle Aged, Models, Statistical, Risk Factors
Check for Full Text / PubMed Unique Identifier (PMID): 17062223
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