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Is surgery always mandatory for type A aortic dissection?

Paolo Centofanti1, Roberto Flocco, Fabrizio Ceresa

  • 1Cardiac Surgery Division, University of Turin, Turin, Italy. paolocentofanti@tiscali.it

The Annals of Thoracic Surgery
|October 26, 2006
PubMed
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A new score helps predict in-hospital mortality for patients with type A acute aortic dissection. This tool aids in deciding between surgery and medical treatment when predicted mortality exceeds 58%.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Aortic Diseases

Background:

  • 42% of patients with type A acute aortic dissection (AAAD) survived with medical management alone.
  • The need for a predictive tool to guide treatment strategies for AAAD is critical.
  • Previous studies highlighted variability in outcomes for unoperated AAAD patients.

Purpose of the Study:

  • To develop a preoperative score for predicting in-hospital mortality in patients with AAAD.
  • To propose an alternative treatment strategy based on predicted mortality.
  • To refine surgical decision-making for complex aortic dissections.

Main Methods:

  • Analysis of 616 consecutive patients with AAAD who underwent surgery between 1980 and 2004.
  • Univariate analysis of preoperative risk factors, with p < 0.05 entered into multivariate analysis.

Related Experiment Videos

  • Development of a logistic regression model to predict mortality: predicted mortality = exp(beta 0 + sigma beta i X i)/[1 + exp(beta 0 + sigma beta i X i)].

    • Main Results:

    • Overall early mortality was 25.1% (154/616 patients).
    • Five independent predictors of mortality were identified: age, coma, acute renal failure, shock, and reoperation.
    • Specific beta coefficients were determined for each risk factor and the constant term.

    Conclusions:

    • A validated mathematical model can predict 30-day mortality for type A acute aortic dissection.
    • Surgery is recommended when predicted mortality is 58% or less.
    • For predicted mortality >58%, a personalized approach comparing surgery and medical management is advised.