Predictive Factors of Mortality in Acute Aortic Dissection and Validity of the EuroSCORE Algorithm in a Small-Sized Cardiac Surgery Institution

Abstract

Introduction Acute aortic dissection (AAD) is a devastating surgical emergency, with high operative mortality. Several scoring algorithms have been used to establish the expected mortality in these patients. Our objective was to define the predictive factors for mortality in our center and to validate the EuroSCORE and Penn classification system. Methods Patients who underwent surgery for AAD from 2006 to 2016 were retrieved from the institution’s database. Preoperative, operative and postoperative variables were collected. Observed and expected mortality was calculated by EuroSCORE. Logistic regression analysis and Cox regression analysis were performed to find predictors of operative mortality and survival, respectively. The receiver operating characteristic (ROC) curves were plotted for logistic EuroSCORE, and the area under the ROC curve (AUC) was calculated. Results 87 patients (27.6% female) underwent surgery for AAD. The mean age was 58.6±9.7 years. Expected and observed operative mortality was 25.8±15.1% and 20.7%, respectively. Penn Aa, Ab and Abc shared similar observed/expected (O/E) mortality ratio. The only independent predictor of operative mortality (OR: 3.63; 95% CI: 1.19-11.09) and survival (HR: 2.6; 95% CI: 1.5-4.8) was female gender. EuroSCORE showed a very poor prediction capacity, with an AUC=0.566. Conclusion Female gender was the only independent predictor of operative mortality and survival in our institution. EuroSCORE is a poor scoring algorithm to predict mortality in AAD, but with consistent results for Penn Aa, Ab and Abc.

Replace it or preserve it? How outcomes differ using different techniques

“…Euroscore II has been shown to be of poor predictive value in aortic surgery 2 and more so in ATAAD. 3 In addition, the ARR group had more patients with connective tissue disease. The difference did not reach statistical significance (p = .289); however, it could not be totally dismissed in a small cohort.…”

“…Extensive disease at presentation, illustrated through a larger aortic root and weaker aortic tissue viability, was not reflected in the operative risk assessment 6 . This can propagate inflated mortality in the ARR cohort 3 …”

“…6 This can propagate inflated mortality in the ARR cohort. 3 The long-term freedom from significant regurgitation across the native aortic valve was addressed by Hartley 1 and colleagues. The study claims that valve resuspension can have good long-term results, however, there are several points to consider.…”

“…This difference was masked in the analysis by a comparable Euroscore II in both groups. Euroscore II has been shown to be of poor predictive value in aortic surgery 2 and more so in ATAAD 3 . In addition, the ARR group had more patients with connective tissue disease.…”