Modifiable Risk Factors for Early Mortality in Low-Risk Penn Class Aa Acute Type A Aortic Dissection Patients - A...

Acute Type A aortic dissection (ATAAD) without end-organ or generalized ischemia is Penn class Aa and considered low-risk. Nevertheless, surgical mortality can be considerable in this subgroup and may be related to modifiable factors. The objective of this study was to analyze 30-day mortality among ATAAD Penn class Aa patients with special reference to modifiable perioperative factors.

Among all patients operated for ATAAD from 1990 to 2010, all Penn class Aa patients dying within 30 days were included in a retrospective descriptive study. Pre- and intraoperative variables related to 30-day mortality were retrieved from medical records and analyzed according to avoidable or modifiable errors such as initial misdiagnosis, preoperative delay, adverse events, and forced and unforced additional procedures.

Overall 30-day mortality was 13% (31/235). Intraoperative death occurred in 32% (10/31) of patients. Among patients not dying intraoperatively, stroke was the most common complication (48%) and cause of death overall, followed by reoperation for bleeding (33%), respiratory failure (24%), and renal failure (14%). Preoperative errors were detected in 48% of patients; one-third had initial misdiagnosis and/or diagnostic delay ≥ 24 hours. Intraoperative error(s) was noted in 74% of patients, mainly involving adverse event(s), forced additional procedures, and assisted bleeding control, with each affecting approximately 45% of patients.

Modifiable errors in pre- and intraoperative management are not uncommon among Penn class Aa patients and may contribute to 30-day mortality. Efforts should be made to mitigate the effects of modifiable factors to reduce early mortality in low-risk ATAAD.