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Ann Thorac Surg 2001;71:1239-1243
© 2001 The Society of Thoracic Surgeons
a Department of Cardiovascular Surgery, Omiya Medical Center, Jichi Medical School, Saitama, Japan
Accepted for publication November 19, 2000.
Address reprint requests to Dr Kawahito, Omiya Medical Center, Jichi Medical School, 1-847 Amanuma, Omiya, Saitama 330-8503, Japan
e-mail: kawahito{at}omiya.jichi.ac.jp
Background. Acute type A dissection is associated with postoperative complications and a high mortality rate. This study was performed to determine the perioperative risk factors leading to hospital mortality in patients with acute type A aortic dissection.
Methods. One hundred twenty-two patients with acute type A aortic dissection treated surgically within 48 hours after onset were enrolled in this study. Thirty-two perioperative risk factors were used in statistical analysis for prediction of mortality. Risk factors for hospital death were investigated with univariate and multiple logistic regression analysis.
Results. The in-hospital mortality rate including operative death was 12.3% (15 of 122 patients) and the actuarial survival rate (including in-hospital death) was 72% ± 6% at 5 years. Univariate analysis revealed 10 risk factors to be statistically significant predictors of hospital death: age, year of operation (1990 to 1995), Marfan syndrome, preoperative ST segment elevation, heart failure from aortic regurgitation, preoperative shock, preoperative coma, long operation time (> 6 hours), long cardiopulmonary bypass time (> 4 hours), and massive blood transfusion (> 20 units) (p < 0.05). Multiple logistic regression analysis confirmed preoperative ST-T segment elevation and massive blood transfusion to be statistically significant independent risk factors for hospital death (p < 0.05).
Conclusions. Preoperative ST-T elevation and massive blood transfusion during operation were identified as significant independent risk factors for hospital mortality after operation for acute type A aortic dissection. Our findings should contribute to estimation of operative risk in individual patients.
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