ABSTRACT
Objective:
To investigate the perioperative
complications and
risk factors of postoperative
death in
patients with acute Stanford type A
aortic dissection (ATAAD).
Methods:
The perioperative data of 228
patients with ATAAD
who underwent continuous
surgery in the Affiliated
Hospital of Jining Medical
University from January 2013 to July 2021 were retrospectively analyzed. The
complications were analyzed. According to the
survival within 30 days after
surgery, they were divided into
death group (24 cases) and
survival group (204 cases). The
risk factors of postoperative
death were analyzed by univariate and multivariate
logistic regression. The
receiver operating characteristic (ROC) curve was drawed to evaluate the predictive
efficacy of various
risk factors on postoperative
death of ATAAD
patients.
Results:
The first three
complications before operation were
hypoxemia (10.1%, 23/228),
pericardial tamponade (7.9%, 18/228),
renal insufficiency (5.3%, 12/228), the first three
complications after
surgery were
hypoxemia (75.8%, 173/228),
renal insufficiency (26.8%, 61/228) and
liver insufficiency (26.3%, 60/228). A total of 24
patients died, the fatality rate was 10.5%(24/228).
Logistic regression analysis showed that age≥55 years old ( OR=7.733, 95% CI 1.986-30.111, P=0.003), preoperative
pericardial tamponade ( OR=5.641, 95% CI 1.546-20.577, P=0.009),
cardiopulmonary bypass time (CBP)≥200 min ( OR=1.008, 95% CI 1.002-1.014, P=0.007) and postoperative
renal insufficiency ( OR=5.875, 95% CI 1.927-17.907, P=0.002) were independent
risk factors for early
death after ATAAD. The area under the
ROC curves of
joint prediction was 0.905 (95% CI 0.820-0.950, P<0.01). The
sensitivity and specificity of
joint prediction were 88.4%, 76.5%, respectively.
Conclusions:
ATAAD has many perioperative
complications and high
mortality. Age≥55 years old, preoperative
pericardial tamponade, CPB
time≥200 min, and postoperative
renal insufficiency were independent
risk factors for postoperative
death in ATAAD
patients.