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Classification of the Urgency of the Procedure and Outcome of Acute Type A Aortic Dissection
F. Biancari, AM. Dell'Aquila, F. Onorati, C. Rossetti, T. Demal, A. Rukosujew, S. Peterss, J. Buech, A. Fiore, T. Folliguet, A. Perrotti, A. Hervé, F. Nappi, L. Conradi, AG. Pinto, JR. Lega, M. Pol, P. Kacer, K. Wisniewski, E. Mazzaro, G. Gatti,...
Jazyk angličtina Země Spojené státy americké
Typ dokumentu multicentrická studie, časopisecké články
NLK
ProQuest Central
od 2012-08-15 do Před 2 měsíci
Nursing & Allied Health Database (ProQuest)
od 2012-08-15 do Před 2 měsíci
Health & Medicine (ProQuest)
od 2012-08-15 do Před 2 měsíci
- MeSH
- azidy * MeSH
- deoxyglukosa analogy a deriváty MeSH
- disekce aorty * chirurgie MeSH
- kohortové studie MeSH
- lidé MeSH
- prognóza MeSH
- retrospektivní studie MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- Publikační typ
- časopisecké články MeSH
- multicentrická studie MeSH
Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
Baylor Scott and White Health Dallas Texas
Cardiac Surgery Molinette Hospital University of Turin Turin Italy
Cardiothoracic Department University Hospital Udine Italy
Cardiovascular Surgery Department University Hospital Gregorio Marañón Madrid Spain
Department of Cardiac Surgery Centre Cardiologique du Nord de Saint Denis Paris France
Department of Cardiac Surgery Centre Hospitalier Annecy Genevois Epagny Metz Tessy France
Department of Cardiac Surgery Glenfield Hospital Leicester United Kingdom
Department of Cardiac Surgery LMU University Hospital Ludwig Maximilian University Munich Germany
Department of Cardiac Surgery Ziekenhuis Oost Limburg Genk Belgium
Department of Cardiothoracic Surgery University Hospital Muenster Muenster Germany
Department of Cardiovascular Surgery University Heart and Vascular Center Hamburg Hamburg Germany
Department of Medicine South Karelia Central Hospital University of Helsinki Lappeenranta Finland
Department of Thoracic and Cardiovascular Surgery University of Franche Comte Besancon France
Division of Cardiac Surgery University of Verona Medical School Verona Italy
German Centre for Cardiovascular Research Partner Site Munich Heart Alliance Munich Germany
Heart and Lung Center Helsinki University Hospital University of Helsinki Helsinki Finland
Heart Center Turku University Hospital University of Turku Turku Finland
National Center for Global Health Istituto Superiore di Sanitá Rome Italy
Research Unit of Surgery Anesthesia and Critical Care University of Oulu Oulu Finland
Citace poskytuje Crossref.org
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- $a Biancari, Fausto $u Department of Medicine, South-Karelia Central Hospital, University of Helsinki, Lappeenranta, Finland; Heart and Lung Center, Helsinki University Hospital, University of Helsinki, Helsinki, Finland. Electronic address: faustobiancari@yahoo.it
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- $a Surgery for type A aortic dissection (TAAD) is associated with a high risk of early mortality. The prognostic impact of a new classification of the urgency of the procedure was evaluated in this multicenter cohort study. Data on consecutive patients who underwent surgery for acute TAAD were retrospectively collected in the multicenter, retrospective European Registry of TAAD (ERTAAD). The rates of in-hospital mortality of 3,902 consecutive patients increased along with the ERTAAD procedure urgency grades: urgent procedure 10.0%, emergency procedure grade 1 13.3%, emergency procedure grade 2 22.1%, salvage procedure grade 1 45.6%, and salvage procedure grade 2 57.1% (p <0.0001). Preoperative arterial lactate correlated with the urgency grades. Inclusion of the ERTAAD procedure urgency classification significantly improved the area under the receiver operating characteristics curves of the regression model and the integrated discrimination indexes and the net reclassification indexes. The risk of postoperative stroke/global brain ischemia, mesenteric ischemia, lower limb ischemia, dialysis, and acute heart failure increased along with the urgency grades. In conclusion, the urgency of surgical repair of acute TAAD, which seems to have a significant impact on the risk of in-hospital mortality, may be useful to improve the stratification of the operative risk of these critically ill patients. This study showed that salvage surgery for TAAD is justified because half of the patients may survive to discharge.
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