Frontiers in Cardiovascular Medicine (Jan 2024)

Baseline risk factors of in-hospital mortality after surgery for acute type A aortic dissection: an ERTAAD study

  • Fausto Biancari,
  • Fausto Biancari,
  • Till Demal,
  • Francesco Nappi,
  • Francesco Onorati,
  • Alessandra Francica,
  • Sven Peterss,
  • Joscha Buech,
  • Joscha Buech,
  • Antonio Fiore,
  • Thierry Folliguet,
  • Andrea Perrotti,
  • Amélie Hervé,
  • Lenard Conradi,
  • Andreas Rukosujew,
  • Angel G. Pinto,
  • Javier Rodriguez Lega,
  • Marek Pol,
  • Jan Rocek,
  • Petr Kacer,
  • Konrad Wisniewski,
  • Enzo Mazzaro,
  • Igor Vendramin,
  • Daniela Piani,
  • Luisa Ferrante,
  • Mauro Rinaldi,
  • Eduard Quintana,
  • Robert Pruna-Guillen,
  • Sebastien Gerelli,
  • Dario Di Perna,
  • Metesh Acharya,
  • Giovanni Mariscalco,
  • Mark Field,
  • Manoj Kuduvalli,
  • Matteo Pettinari,
  • Stefano Rosato,
  • Paola D’Errigo,
  • Mikko Jormalainen,
  • Caius Mustonen,
  • Timo Mäkikallio,
  • Angelo M. Dell’Aquila,
  • Angelo M. Dell’Aquila,
  • Tatu Juvonen,
  • Tatu Juvonen,
  • Giuseppe Gatti

DOI
https://doi.org/10.3389/fcvm.2023.1307935
Journal volume & issue
Vol. 10

Abstract

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BackgroundSurgery for type A aortic dissection (TAAD) is associated with high risk of mortality. Current risk scoring methods have a limited predictive accuracy.MethodsSubjects were patients who underwent surgery for acute TAAD at 18 European centers of cardiac surgery from the European Registry of Type A Aortic Dissection (ERTAAD).ResultsOut of 3,902 patients included in the ERTAAD, 2,477 fulfilled the inclusion criteria. In the validation dataset (2,229 patients), the rate of in-hospital mortality was 18.4%. The rate of composite outcome (in-hospital death, stroke/global ischemia, dialysis, and/or acute heart failure) was 41.2%, and 10-year mortality rate was 47.0%. Logistic regression identified the following patient-related variables associated with an increased risk of in-hospital mortality [area under the curve (AUC), 0.755, 95% confidence interval (CI), 0.729–0.780; Brier score 0.128]: age; estimated glomerular filtration rate; arterial lactate; iatrogenic dissection; left ventricular ejection fraction ≤50%; invasive mechanical ventilation; cardiopulmonary resuscitation immediately before surgery; and cerebral, mesenteric, and peripheral malperfusion. The estimated risk score was associated with an increased risk of composite outcome (AUC, 0.689, 95% CI, 0.667–0.711) and of late mortality [hazard ratio (HR), 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403]. In the validation dataset (248 patients), the in-hospital mortality rate was 16.1%, the composite outcome rate was 41.5%, and the 10-year mortality rate was 49.1%. The estimated risk score was predictive of in-hospital mortality (AUC, 0.703, 95% CI, 0.613–0.793; Brier score 0.121; slope 0.905) and of composite outcome (AUC, 0.682, 95% CI, 0.614–0.749). The estimated risk score was predictive of late mortality (HR, 1.035, 95% CI, 1.031–1.038; Harrell's C 0.702; Somer's D 0.403), also when hospital deaths were excluded from the analysis (HR, 1.024, 95% CI, 1.018–1.031; Harrell's C 0.630; Somer's D 0.261).ConclusionsThe present analysis identified several baseline clinical risk factors, along with preoperative estimated glomerular filtration rate and arterial lactate, which are predictive of in-hospital mortality and major postoperative adverse events after surgical repair of acute TAAD. These risk factors may be valuable components for risk adjustment in the evaluation of surgical and anesthesiological strategies aiming to improve the results of surgery for TAAD.Clinical Trial Registrationhttps://clinicaltrials.gov, identifier NCT04831073.

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