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Ann Thorac Surg 2002;73:714-718
© 2002 The Society of Thoracic Surgeons

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Original article: cardiovascular

Factors influencing intensive care unit length of stay after surgery for acute aortic dissection type A

^a Department of Cardiac Surgery, Innsbruck University Hospital Innsbruck, Austria
^b Division for General and Surgical Intensive Care Medicine, Innsbruck University Hospital, Innsbruck, Austria

Accepted for publication November 19, 2001.

* Address reprint requests to Dr Bonatti, Department of Cardiac Surgery, Innsbruck University Hospital, Anichstrasse 35, A-6020 Innsbruck, Austria
e-mail: johannes.o.bonatti{at}uibk.ac.at

Background. Operative mortality after acute aortic dissection type A is still high, and prolonged stay at the intensive care unit is common. Little has been documented about factors influencing the intensive care unit length of stay. The aim of this study was to determine such variables.

Methods. During a 10-year period, 67 patients (47 male, 20 female) were operated on for acute aortic dissection type A. In 42 patients (63%), an ascending aortic replacement was performed, 23 patients (34%) underwent a Bentall procedure, and 2 patients (3%) received a valve-sparing David type of operation. In 14 of these cases (20%), an additional partial or total arch replacement was performed.

Results. Hospital mortality was 9 of 67 (14%). Median postoperative intensive care unit length of stay was 5 days (range, 1 to 72 days). Intensive care unit stay was in univariate analysis significantly influenced by the following factors: age (p = 0.008), body mass index (p = 0.039), cardiopulmonary bypass time (p = 0.018), aortic cross-clamp time (p = 0.031), postoperative low cardiac output syndrome (p < 0.001), and postoperative lactate levels (p = 0.01). By multivariate analysis, age (p = 0.012), cardiopulmonary bypass time (p = 0.037), and the presence of a postoperative low cardiac output syndrome (p < 0.001) significantly influenced intensive care unit stay.

Conclusions. Stay in the intensive care unit after operation for acute aortic dissection type A seems to be determined by age, cardiopulmonary bypass time, and the postoperative presence of a low cardiac output syndrome.

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Invited commentary

Marc A.A.M. Schepens
Ann. Thorac. Surg. 2002 73: 718-719. [Extract] [Full Text] [PDF]

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